- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.85 / $3,666.78 / $12,765.09
| Facility | | $479.85 | $3,666.78 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.27 / $476.64 / $1,156.78
| Professional | | $314.27 | $476.64 | $1,156.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.78 / $493.17 / $657.56
| Professional | | $328.78 | $493.17 | $657.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.35 / $6,198.03 / $11,988.99
| Facility | | $4,712.35 | $6,198.03 | $11,988.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.20 / $657.39 / $983.97
| Professional | | $358.20 | $657.39 | $983.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.95 / $1,009.74 / $1,490.03
| Professional | | $621.95 | $1,009.74 | $1,490.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.81 / $636.61 / $1,711.20
| Facility | | $397.81 | $636.61 | $1,711.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.84 / $1,073.08 / $2,725.84
| Professional | | $648.84 | $1,073.08 | $2,725.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $799.85 / $1,125.90 / $2,842.49
| Facility | | $799.85 | $1,125.90 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.92 / $969.33 / $1,384.04
| Professional | | $729.92 | $969.33 | $1,384.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.84 / $1,073.08 / $1,397.51
| Professional | | $648.84 | $1,073.08 | $1,397.51 |