- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.23 / $1,471.14 / $2,395.85
| Facility | | $687.23 | $1,471.14 | $2,395.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.15 / $458.15 / $714.55
| Professional | | $458.15 | $458.15 | $714.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.26 / $336.26 / $840.65
| Professional | | $336.26 | $336.26 | $840.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.78 / $1,775.87 / $2,936.54
| Facility | | $1,008.78 | $1,775.87 | $2,936.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.01 / $1,207.51 / $4,051.93
| Professional | | $966.01 | $1,207.51 | $4,051.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $1,092.84 / $1,891.46
| Facility | | $319.00 | $1,092.84 | $1,891.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.26 / $495.98 / $1,572.02
| Professional | | $336.26 | $495.98 | $1,572.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.50 / $798.62 / $979.48
| Professional | | $526.50 | $798.62 | $979.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $1,775.87 / $3,026.47
| Facility | | $597.00 | $1,775.87 | $3,026.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.41 / $840.65 / $1,731.74
| Professional | | $546.41 | $840.65 | $1,731.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.07 / $472.87 / $1,234.69
| Professional | | $353.07 | $472.87 | $1,234.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.49 / $966.73 / $966.73
| Facility | | $858.49 | $966.73 | $966.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.50 / $840.65 / $1,010.39
| Professional | | $526.50 | $840.65 | $1,010.39 |