- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,698.24 / $10,471.29
| Facility | | $512.86 | $1,698.24 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $549.54 / $1,318.26
| Professional | | $478.63 | $549.54 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,949.84
| Facility | | $1,905.46 | $1,905.46 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $912.01 / $1,445.44
| Professional | | $562.34 | $912.01 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $1,288.25
| Professional | | $537.03 | $724.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $1,202.26
| Professional | | $812.83 | $812.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $691.83 / $1,096.48
| Facility | | $512.86 | $691.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $891.25 / $1,148.15
| Professional | | $691.83 | $891.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,918.31 / $10,471.29
| Facility | | $2,187.76 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $575.44 / $1,071.52
| Professional | | $426.58 | $575.44 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $16,595.87 / $16,595.87
| Facility | | $1,995.26 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $4,897.79
| Professional | | $4,897.79 | $4,897.79 | $4,897.79 |