- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,467.37 / $7,244.36
| Facility | | $602.56 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $1,513.56
| Professional | | $457.09 | $630.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $933.25
| Professional | | $446.68 | $645.65 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $2,884.03 / $4,365.16
| Professional | | $446.68 | $2,884.03 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $660.69 / $1,122.02
| Professional | | $446.68 | $660.69 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $724.44 / $933.25
| Professional | | $407.38 | $724.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $707.95 / $891.25
| Professional | | $645.65 | $707.95 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $1,122.02
| Facility | | $446.68 | $676.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $602.56 / $8,709.64
| Facility | | $416.87 | $602.56 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $8,709.64
| Professional | | $549.54 | $812.83 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $1,023.29
| Professional | | $363.08 | $537.03 | $1,023.29 |