- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,318.26 / $7,244.36
| Facility | | $524.81 | $1,318.26 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $691.83 / $1,318.26
| Professional | | $416.87 | $691.83 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,318.26
| Facility | | $1,288.25 | $1,288.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $645.65 / $1,445.44
| Professional | | $407.38 | $645.65 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $724.44 / $1,348.96
| Professional | | $354.81 | $724.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,819.70
| Professional | | $851.14 | $851.14 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $707.95 / $1,122.02
| Facility | | $389.05 | $707.95 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,258.93 / $1,621.81
| Professional | | $1,000.00 | $1,258.93 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,890.45 / $6,606.93
| Facility | | $1,230.27 | $3,890.45 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $602.56 / $1,122.02
| Professional | | $338.84 | $602.56 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $28,840.32
| Facility | | $21,379.62 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $6,025.60
| Professional | | $5,495.41 | $5,495.41 | $6,025.60 |