- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,187.76 / $3,715.35
| Facility | | $1,071.52 | $2,187.76 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $676.08 / $977.24
| Professional | | $549.54 | $676.08 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,288.25 / $2,884.03
| Facility | | $562.34 | $1,288.25 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $1,202.26
| Professional | | $954.99 | $954.99 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $501.19 / $1,230.27
| Professional | | $398.11 | $501.19 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Facility | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $724.44 / $1,445.44
| Professional | | $630.96 | $724.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,137.96 / $3,715.35
| Facility | | $977.24 | $2,137.96 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $3,019.95
| Professional | | $562.34 | $707.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $831.76
| Facility | | $630.96 | $630.96 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $630.96 / $851.14
| Professional | | $281.84 | $630.96 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $831.76 / $1,000.00
| Facility | | $457.09 | $831.76 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $1,258.93
| Professional | | $354.81 | $501.19 | $1,258.93 |