- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,630.27 / $8,317.64
| Facility | | $707.95 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $1,513.56
| Professional | | $457.09 | $630.96 | $1,513.56 |
- 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
- $512.86 / $758.58 / $1,071.52
| Professional | | $512.86 | $758.58 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $2,691.53 / $5,495.41
| Professional | | $524.81 | $2,691.53 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $1,023.29
| Professional | | $457.09 | $630.96 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $549.54 / $707.95
| Professional | | $467.74 | $549.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $660.69 / $691.83
| Professional | | $616.60 | $660.69 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $645.65 / $1,047.13
| Facility | | $478.63 | $645.65 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $676.08 / $8,709.64
| Facility | | $407.38 | $676.08 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $676.08 / $8,709.64
| Professional | | $407.38 | $676.08 | $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
- $371.54 / $512.86 / $933.25
| Professional | | $371.54 | $512.86 | $933.25 |