- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,995.26 / $2,137.96
| Facility | | $616.60 | $1,995.26 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $741.31
| Professional | | $489.78 | $575.44 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $2,089.30
| Professional | | $549.54 | $812.83 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,995.26 / $3,162.28
| Facility | | $1,698.24 | $1,995.26 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,548.82 / $2,187.76
| Professional | | $758.58 | $1,548.82 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $660.69 / $1,096.48
| Facility | | $537.03 | $660.69 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Professional | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $660.69 / $1,230.27
| Facility | | $537.03 | $660.69 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,023.29 / $3,801.89
| Professional | | $588.84 | $1,023.29 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $85.11
| Professional | | $32.36 | $60.26 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,479.11 / $2,187.76
| Professional | | $851.14 | $1,479.11 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $3,801.89
| Facility | | $1,412.54 | $1,412.54 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $2,630.27 / $3,801.89
| Professional | | $724.44 | $2,630.27 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Professional | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $3,162.28 / $3,548.13
| Professional | | $707.95 | $3,162.28 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,318.26
| Facility | | $1,000.00 | $1,000.00 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $912.01 / $1,819.70
| Professional | | $588.84 | $912.01 | $1,819.70 |