- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,630.27 / $7,762.47
| Facility | | $912.01 | $2,630.27 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $562.34 / $851.14
| Professional | | $446.68 | $562.34 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Professional | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Professional | 50 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,943.28 / $12,882.50
| Facility | | $5,128.61 | $7,943.28 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $588.84 / $812.83
| Professional | | $426.58 | $588.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $602.56 / $851.14
| Professional | | $426.58 | $602.56 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $891.25 / $5,888.44
| Facility | | $512.86 | $891.25 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $4,677.35
| Professional | | $512.86 | $645.65 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,235.94 / $5,888.44
| Facility | | $891.25 | $3,235.94 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $707.95
| Professional | | $398.11 | $524.81 | $707.95 |