- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,621.81 / $6,760.83
| Facility | | $812.83 | $1,621.81 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $1,122.02
| Professional | | $323.59 | $512.86 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,235.94 / $7,413.10
| Facility | | $1,348.96 | $3,235.94 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $954.99
| Professional | | $575.44 | $724.44 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $537.03 / $794.33
| Professional | | $371.54 | $537.03 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $645.65 / $1,174.90
| Facility | | $338.84 | $645.65 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $794.33 / $1,047.13
| Professional | | $537.03 | $794.33 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,456.54 / $8,912.51
| Facility | | $4,570.88 | $6,456.54 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $691.83 / $1,023.29
| Professional | | $501.19 | $691.83 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $616.60 / $3,890.45
| Professional | | $436.52 | $616.60 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,495.41 / $12,302.69
| Facility | | $1,348.96 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $549.54 / $851.14
| Professional | | $354.81 | $549.54 | $851.14 |