- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.12 / $1,504.86 / $2,462.79
| Facility | | $552.12 | $1,504.86 | $2,462.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.75 / $552.12 / $991.51
| Professional | | $522.75 | $552.12 | $991.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.60 / $1,008.30 / $2,752.53
| Facility | | $528.60 | $1,008.30 | $2,752.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.14 / $579.48 / $1,411.50
| Professional | | $278.14 | $579.48 | $1,411.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,021.09 / $1,626.01 / $2,842.68
| Facility | | $1,021.09 | $1,626.01 | $2,842.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.71 / $544.71 / $741.42
| Professional | | $544.71 | $544.71 | $741.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.92 / $853.85 / $1,964.35
| Facility | | $404.92 | $853.85 | $1,964.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.45 / $640.74 / $1,305.29
| Professional | | $348.45 | $640.74 | $1,305.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,645.55 / $9,239.00
| Facility | | $83.43 | $3,645.55 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.94 / $835.94 / $983.46
| Professional | | $835.94 | $835.94 | $983.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.48 / $803.16 / $2,156.86
| Professional | | $579.48 | $803.16 | $2,156.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.30 / $2,752.53 / $2,752.53
| Facility | | $1,008.30 | $2,752.53 | $2,752.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.10 / $347.69 / $1,223.33
| Professional | | $191.10 | $347.69 | $1,223.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.10 / $347.69 / $2,175.96
| Professional | | $191.10 | $347.69 | $2,175.96 |