- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,513.56 / $13,803.84
| Facility | | $1,174.90 | $1,513.56 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $1,513.56
| Professional | | $512.86 | $645.65 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,047.13 / $1,584.89
| Professional | | $602.56 | $1,047.13 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,174.90 / $1,412.54
| Professional | | $891.25 | $1,174.90 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $870.96 / $1,412.54
| Facility | | $575.44 | $870.96 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $1,513.56
| Professional | | $851.14 | $1,023.29 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,096.48 / $1,174.90
| Facility | | $794.33 | $1,096.48 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,258.93
| Facility | | $588.84 | $870.96 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,096.48 / $1,548.82
| Professional | | $79.43 | $1,096.48 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,620.87 / $22,387.21
| Facility | | $13,803.84 | $18,620.87 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,202.26 / $1,698.24
| Professional | | $933.25 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,782.79 / $25,703.96
| Facility | | $2,884.03 | $17,782.79 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,096.48 / $1,584.89
| Professional | | $741.31 | $1,096.48 | $1,584.89 |