- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.47 / $1,500.52 / $2,549.91
| Facility | | $1,008.47 | $1,500.52 | $2,549.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.91 / $574.91 / $574.91
| Professional | | $574.91 | $574.91 | $574.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.37 / $676.37 / $3,324.36
| Facility | | $676.37 | $676.37 | $3,324.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.36 / $180.36 / $283.25
| Professional | | $180.36 | $180.36 | $283.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.10 / $541.10 / $1,055.14
| Professional | | $541.10 | $541.10 | $1,055.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.64 / $1,263.83 / $3,465.62
| Facility | | $439.64 | $1,263.83 | $3,465.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.90 / $823.90 / $987.13
| Professional | | $823.90 | $823.90 | $987.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.37 / $811.64 / $1,001.03
| Professional | | $676.37 | $811.64 | $1,001.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.72 / $676.37 / $1,052.08
| Facility | | $537.72 | $676.37 | $1,052.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.00 / $1,339.21 / $1,623.29
| Professional | | $798.00 | $1,339.21 | $1,623.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.46 / $676.37 / $1,084.90
| Facility | | $473.46 | $676.37 | $1,084.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.46 / $676.37 / $1,084.90
| Professional | | $473.46 | $676.37 | $1,084.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.08 / $351.71 / $777.83
| Professional | | $284.08 | $351.71 | $777.83 |