- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,288.25 / $8,709.64
| Facility | | $602.56 | $1,288.25 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $691.83 / $1,513.56
| Professional | | $549.54 | $691.83 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $1,513.56
| Professional | | $707.95 | $1,071.52 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $1,047.13
| Facility | | $489.78 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $1,445.44
| Professional | | $616.60 | $891.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $776.25 / $1,202.26
| Facility | | $575.44 | $776.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Professional | | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $954.99 / $1,258.93
| Professional | | $741.31 | $954.99 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,819.70 / $6,309.57
| Facility | | $309.03 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $1,174.90
| Professional | | $501.19 | $676.08 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,623.41 / $5,623.41
| Facility | | $56.23 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $5,370.32
| Professional | | $4,570.88 | $4,570.88 | $5,370.32 |