- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $799.44 / $1,815.88 / $3,254.87
| Facility | | $799.44 | $1,815.88 | $3,254.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.29 / $750.91 / $970.75
| Professional | | $605.29 | $750.91 | $970.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.40 / $1,246.40 / $3,315.42
| Professional | | $1,246.40 | $1,246.40 | $3,315.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.47 / $2,412.61 / $4,111.76
| Facility | | $1,370.47 | $2,412.61 | $4,111.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,391.26 / $5,504.73 / $5,504.73
| Professional | | $1,391.26 | $5,504.73 | $5,504.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $1,484.68 / $2,569.64
| Facility | | $319.00 | $1,484.68 | $2,569.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.44 / $1,484.68 / $2,478.27
| Professional | | $799.44 | $1,484.68 | $2,478.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.75 / $1,142.06 / $2,070.89
| Professional | | $970.75 | $1,142.06 | $2,070.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $2,412.61 / $4,111.76
| Facility | | $555.00 | $2,412.61 | $4,111.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.34 / $1,233.42 / $2,626.74
| Professional | | $742.34 | $1,233.42 | $2,626.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.67 / $685.24 / $1,770.19
| Professional | | $479.67 | $685.24 | $1,770.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.00 / $1,313.34 / $1,313.34
| Facility | | $1,207.00 | $1,313.34 | $1,313.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.75 / $1,207.00 / $1,377.12
| Professional | | $970.75 | $1,207.00 | $1,377.12 |