- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $3,388.44 / $7,943.28
| Facility | | $457.09 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $851.14 / $1,584.89
| Professional | | $354.81 | $851.14 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $537.03 / $776.25
| Professional | | $398.11 | $537.03 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $660.69 / $4,466.84
| Professional | | $436.52 | $660.69 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $758.58 / $1,513.56
| Professional | | $371.54 | $758.58 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,174.90 / $3,019.95
| Professional | | $363.08 | $1,174.90 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $933.25 / $2,398.83
| Professional | | $407.38 | $933.25 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $891.25 / $1,621.81
| Facility | | $371.54 | $891.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $4,073.80
| Facility | | $295.12 | $446.68 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,202.26 / $4,073.80
| Professional | | $707.95 | $1,202.26 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,467.37 / $5,888.44
| Facility | | $1,819.70 | $3,467.37 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $660.69 / $1,513.56
| Professional | | $288.40 | $660.69 | $1,513.56 |