- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.20 / $2,289.94 / $3,356.43
| Facility | | $858.20 | $2,289.94 | $3,356.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.32 / $401.32 / $2,417.31
| Professional | | $401.32 | $401.32 | $2,417.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.07 / $979.07 / $979.07
| Professional | | $979.07 | $979.07 | $979.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.43 / $1,022.54 / $1,977.91
| Facility | | $777.43 | $1,022.54 | $1,977.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.52 / $791.53 / $811.33
| Professional | | $740.52 | $791.53 | $811.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,335.86 / $2,335.86 / $2,335.86
| Facility | | $2,335.86 | $2,335.86 | $2,335.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.00 / $973.50 / $1,216.88
| Professional | | $717.00 | $973.50 | $1,216.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.32 / $893.09 / $3,983.52
| Facility | | $401.32 | $893.09 | $3,983.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.14 / $803.69 / $14,247.44
| Professional | | $473.14 | $803.69 | $14,247.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.71 / $916.56 / $1,458.17
| Facility | | $794.71 | $916.56 | $1,458.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.00 / $886.48 / $1,119.27
| Professional | | $731.00 | $886.48 | $1,119.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.25 / $468.33 / $816.57
| Professional | | $457.25 | $468.33 | $816.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.58 / $803.69 / $1,001.94
| Professional | | $494.58 | $803.69 | $1,001.94 |