- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $4,677.35 / $9,772.37
| Facility | | $512.86 | $4,677.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $1,047.13
| Professional | | $354.81 | $478.63 | $1,047.13 |
- 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
- $380.19 / $549.54 / $776.25
| Professional | | $380.19 | $549.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,513.56 / $2,754.23
| Professional | | $380.19 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $831.76
| Professional | | $363.08 | $512.86 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $660.69
| Professional | | $346.74 | $524.81 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $616.60
| Professional | | $602.56 | $602.56 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $524.81 / $812.83
| Facility | | $380.19 | $524.81 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $4,073.80
| Facility | | $354.81 | $512.86 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $4,073.80
| Professional | | $407.38 | $575.44 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,467.37 / $5,754.40
| Facility | | $1,737.80 | $3,467.37 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $416.87 / $758.58
| Professional | | $302.00 | $416.87 | $758.58 |