- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.65 / $2,340.82 / $6,508.91
| Facility | | $801.65 | $2,340.82 | $6,508.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.21 / $881.82 / $1,082.23
| Professional | | $748.21 | $881.82 | $1,082.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.68 / $1,336.09 / $1,336.09
| Professional | | $1,135.68 | $1,336.09 | $1,336.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.26 / $935.26 / $1,336.09
| Professional | | $935.26 | $935.26 | $1,336.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $879.32 / $3,135.75 / $7,083.03
| Facility | | $879.32 | $3,135.75 | $7,083.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,627.23 / $1,627.23 / $1,949.60
| Professional | | $1,627.23 | $1,627.23 | $1,949.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.73 / $6,346.43 / $6,346.43
| Facility | | $2,137.73 | $6,346.43 | $6,346.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,653.73 / $6,653.73 / $10,020.68
| Professional | | $6,653.73 | $6,653.73 | $10,020.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.65 / $1,336.09 / $1,990.77
| Facility | | $801.65 | $1,336.09 | $1,990.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.09 / $1,336.09 / $1,670.11
| Professional | | $1,336.09 | $1,336.09 | $1,670.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.48 / $1,670.11 / $3,006.20
| Professional | | $1,202.48 | $1,670.11 | $3,006.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.29 / $3,350.61 / $7,197.57
| Facility | | $923.29 | $3,350.61 | $7,197.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,262.74 / $1,469.70 / $2,338.16
| Professional | | $1,262.74 | $1,469.70 | $2,338.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.16 / $1,336.09 / $1,603.31
| Facility | | $561.16 | $1,336.09 | $1,603.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $561.16 / $823.03
| Professional | | $561.16 | $561.16 | $823.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.14 / $423.14 / $1,336.09
| Professional | | $423.14 | $423.14 | $1,336.09 |