- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,467.37 / $5,754.40
| Facility | | $1,174.90 | $3,467.37 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $691.83 / $831.76
| Professional | | $562.34 | $691.83 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,168.69 / $4,265.80
| Facility | | $2,137.96 | $4,168.69 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $1,412.54
| Professional | | $645.65 | $870.96 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $660.69 / $1,949.84
| Professional | | $489.78 | $660.69 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,412.54 / $2,818.38
| Facility | | $549.54 | $1,412.54 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,023.29 / $1,288.25
| Professional | | $602.56 | $1,023.29 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $831.76 / $1,348.96
| Professional | | $100.00 | $831.76 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $1,479.11
| Professional | | $676.08 | $831.76 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $19.95 / $19.95
| Professional | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $977.24 / $2,137.96
| Facility | | $501.19 | $977.24 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $831.76
| Professional | | $602.56 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $457.09 / $831.76
| Facility | | $354.81 | $457.09 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $380.19 / $1,513.56
| Professional | | $354.81 | $380.19 | $1,513.56 |