- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,630.27 / $8,317.64
| Facility | | $776.25 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $1,949.84
| Professional | | $501.19 | $676.08 | $1,949.84 |
- 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
- $549.54 / $831.76 / $1,174.90
| Professional | | $549.54 | $831.76 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $2,691.53 / $5,495.41
| Professional | | $562.34 | $2,691.53 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $707.95 / $1,122.02
| Professional | | $512.86 | $707.95 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $758.58
| Professional | | $501.19 | $588.84 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $831.76 / $891.25
| Professional | | $776.25 | $831.76 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $1,148.15
| Facility | | $512.86 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $758.58 / $8,709.64
| Facility | | $512.86 | $758.58 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $758.58 / $8,709.64
| Professional | | $512.86 | $758.58 | $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
- $416.87 / $575.44 / $1,047.13
| Professional | | $416.87 | $575.44 | $1,047.13 |