- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,011.87 / $12,589.25
| Facility | | $977.24 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $512.86 / $2,290.87
| Professional | | $380.19 | $512.86 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,073.80 / $7,943.28
| Facility | | $3,090.30 | $4,073.80 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $676.08 / $912.01
| Professional | | $398.11 | $676.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,071.52 / $1,380.38
| Professional | | $870.96 | $1,071.52 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $741.31 / $4,265.80
| Facility | | $380.19 | $741.31 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $933.25 / $3,090.30
| Professional | | $645.65 | $933.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,071.52 / $1,348.96
| Professional | | $954.99 | $1,071.52 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,023.29 / $1,258.93
| Professional | | $912.01 | $1,023.29 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,365.16 / $8,128.31
| Facility | | $2,951.21 | $4,365.16 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $851.14 / $1,096.48
| Professional | | $537.03 | $851.14 | $1,096.48 |