- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,454.71
| Facility | | $549.54 | $1,778.28 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $602.56 / $776.25
| Professional | | $524.81 | $602.56 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $478.63 / $1,174.90
| Professional | | $331.13 | $478.63 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $588.84 / $1,258.93
| Facility | | $537.03 | $588.84 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $912.01 / $1,148.15
| Professional | | $794.33 | $912.01 | $1,148.15 |
- 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
- $1,148.15 / $1,148.15 / $1,348.96
| Professional | | $1,148.15 | $1,148.15 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,513.56
| Professional | | $794.33 | $794.33 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $478.63 / $1,174.90
| Professional | | $331.13 | $478.63 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $707.95 / $954.99
| Facility | | $398.11 | $707.95 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $1,174.90
| Professional | | $354.81 | $478.63 | $1,174.90 |