- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.24 / $1,007.98 / $1,265.66
| Facility | | $400.24 | $1,007.98 | $1,265.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.99 / $991.71 / $1,220.43
| Professional | | $822.99 | $991.71 | $1,220.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.63 / $1,127.58 / $3,119.17
| Facility | | $754.63 | $1,127.58 | $3,119.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.02 / $1,375.20 / $5,795.70
| Professional | | $356.02 | $1,375.20 | $5,795.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.17 / $857.91 / $1,074.51
| Facility | | $705.17 | $857.91 | $1,074.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.18 / $928.60 / $1,274.09
| Facility | | $772.18 | $928.60 | $1,274.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,060.88 / $1,743.05 / $2,997.08
| Professional | | $1,060.88 | $1,743.05 | $2,997.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.53 / $1,528.01 / $8,090.00
| Facility | | $898.53 | $1,528.01 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.76 / $993.20 / $1,626.79
| Professional | | $553.76 | $993.20 | $1,626.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.92 / $2,232.29 / $2,946.18
| Professional | | $1,182.92 | $2,232.29 | $2,946.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.31 / $2,001.31 / $5,001.75
| Facility | | $2,001.31 | $2,001.31 | $5,001.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.01 / $1,375.20 / $5,795.70
| Professional | | $565.01 | $1,375.20 | $5,795.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.73 / $1,309.75 / $2,946.18
| Professional | | $582.73 | $1,309.75 | $2,946.18 |