- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,995.26 / $2,630.27
| Facility | | $436.52 | $1,995.26 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $691.83 / $1,737.80
| Professional | | $436.52 | $691.83 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,691.53 / $4,265.80
| Facility | | $977.24 | $2,691.53 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $891.25 / $2,630.27
| Professional | | $537.03 | $891.25 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $691.83 / $1,445.44
| Facility | | $229.09 | $691.83 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,071.52 / $1,819.70
| Professional | | $489.78 | $1,071.52 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,513.56
| Professional | | $1,288.25 | $1,288.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,513.56
| Professional | | $891.25 | $891.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,691.53 / $4,265.80
| Facility | | $977.24 | $2,691.53 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $891.25 / $2,630.27
| Professional | | $537.03 | $891.25 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $891.25 / $1,071.52
| Facility | | $489.78 | $891.25 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $1,513.56
| Professional | | $446.68 | $691.83 | $1,513.56 |