- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,570.40 / $8,317.64
| Facility | | $812.83 | $2,570.40 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $954.99 / $2,570.40
| Professional | | $645.65 | $954.99 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $1,584.89
| Professional | | $758.58 | $1,122.02 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $2,691.53 / $5,495.41
| Professional | | $758.58 | $2,691.53 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $933.25 / $1,513.56
| Professional | | $660.69 | $933.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $812.83 / $1,047.13
| Professional | | $691.83 | $812.83 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,071.52 / $1,202.26
| Professional | | $1,000.00 | $1,071.52 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $977.24 / $1,479.11
| Facility | | $691.83 | $977.24 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $8,709.64
| Facility | | $660.69 | $977.24 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $8,709.64
| Professional | | $660.69 | $977.24 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,348.96
| Professional | | $549.54 | $758.58 | $1,348.96 |