- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.19 / $2,656.68 / $3,174.55
| Facility | | $645.19 | $2,656.68 | $3,174.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $614.83 / $645.19
| Professional | | $455.43 | $614.83 | $645.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.05 / $592.05 / $592.05
| Professional | | $592.05 | $592.05 | $592.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.18 / $986.76 / $2,518.75
| Facility | | $508.18 | $986.76 | $2,518.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,658.62 / $3,658.62 / $3,658.62
| Professional | | $3,658.62 | $3,658.62 | $3,658.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.00 / $1,024.72 / $1,874.85
| Professional | | $797.00 | $1,024.72 | $1,874.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.20 / $2,619.17 / $3,174.55
| Facility | | $845.20 | $2,619.17 | $3,174.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.16 / $645.19 / $3,134.88
| Professional | | $498.16 | $645.19 | $3,134.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.39 / $1,138.58 / $1,518.10
| Professional | | $1,123.39 | $1,138.58 | $1,518.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.18 / $986.76 / $2,518.75
| Facility | | $508.18 | $986.76 | $2,518.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,658.62 / $3,658.62 / $3,658.62
| Professional | | $3,658.62 | $3,658.62 | $3,658.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $759.05
| Facility | | $759.05 | $759.05 | $759.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $759.05
| Professional | | $759.05 | $759.05 | $759.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $455.43 / $1,013.48
| Professional | | $318.80 | $455.43 | $1,013.48 |