- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.34 / $1,206.89 / $2,163.29
| Facility | | $531.34 | $1,206.89 | $2,163.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.30 / $499.08 / $645.19
| Professional | | $402.30 | $499.08 | $645.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $1,587.04
| Professional | | $500.00 | $500.00 | $1,587.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.86 / $1,603.49 / $2,733.02
| Facility | | $910.86 | $1,603.49 | $2,733.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.59 / $3,658.62 / $3,658.62
| Professional | | $924.59 | $3,658.62 | $3,658.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $910.86 / $1,707.86
| Facility | | $294.00 | $910.86 | $1,707.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.00 / $994.36 / $1,647.14
| Professional | | $797.00 | $994.36 | $1,647.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.19 / $749.66 / $1,376.38
| Professional | | $645.19 | $749.66 | $1,376.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $1,603.49 / $2,733.02
| Facility | | $597.00 | $1,603.49 | $2,733.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.38 / $819.77 / $1,745.82
| Professional | | $493.38 | $819.77 | $1,745.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $455.43 / $1,332.06
| Professional | | $318.80 | $455.43 | $1,332.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.16 / $872.89 / $872.89
| Facility | | $775.16 | $872.89 | $872.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.19 / $775.16 / $912.31
| Professional | | $645.19 | $775.16 | $912.31 |