- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,454.71
| Facility | | $549.54 | $1,778.28 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $602.56 / $741.31
| Professional | | $512.86 | $602.56 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,089.30 / $3,715.35
| Facility | | $870.96 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $794.33 / $2,951.21
| Professional | | $467.74 | $794.33 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $1,258.93
| Facility | | $537.03 | $616.60 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $1,148.15
| Professional | | $954.99 | $954.99 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,348.96
| Professional | | $1,148.15 | $1,148.15 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,258.93
| Professional | | $794.33 | $794.33 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,089.30 / $3,715.35
| Facility | | $870.96 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $794.33 / $2,951.21
| Professional | | $467.74 | $794.33 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $794.33 / $954.99
| Facility | | $467.74 | $794.33 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $616.60 / $1,380.38
| Professional | | $467.74 | $616.60 | $1,380.38 |