- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,905.46 / $2,630.27
| Facility | | $588.84 | $1,905.46 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $676.08 / $812.83
| Professional | | $562.34 | $676.08 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,238.72 / $3,981.07
| Facility | | $933.25 | $2,238.72 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $851.14 / $3,162.28
| Professional | | $512.86 | $851.14 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $660.69 / $1,348.96
| Facility | | $575.44 | $660.69 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,230.27
| Professional | | $1,023.29 | $1,023.29 | $1,230.27 |
- 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
- $1,230.27 / $1,230.27 / $1,445.44
| Professional | | $1,230.27 | $1,230.27 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,047.13 / $1,949.84
| Professional | | $724.44 | $1,047.13 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,238.72 / $3,981.07
| Facility | | $933.25 | $2,238.72 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $851.14 / $3,162.28
| Professional | | $512.86 | $851.14 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $851.14 / $1,023.29
| Facility | | $512.86 | $851.14 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $660.69 / $1,862.09
| Professional | | $512.86 | $660.69 | $1,862.09 |