- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,995.26 / $2,818.38
| Facility | | $630.96 | $1,995.26 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $676.08 / $870.96
| Professional | | $588.84 | $676.08 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $537.03 / $1,348.96
| Professional | | $380.19 | $537.03 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $691.83 / $1,445.44
| Facility | | $602.56 | $691.83 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,096.48 / $1,380.38
| Professional | | $1,023.29 | $1,096.48 | $1,380.38 |
- 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
- $1,288.25 / $1,288.25 / $1,513.56
| Professional | | $1,288.25 | $1,288.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,995.26
| Professional | | $891.25 | $891.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $537.03 / $1,348.96
| Professional | | $380.19 | $537.03 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $812.83 / $1,071.52
| Facility | | $446.68 | $812.83 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $691.83 / $2,041.74
| Professional | | $407.38 | $691.83 | $2,041.74 |