- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $4,168.69 / $8,511.38
| Facility | | $954.99 | $4,168.69 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $2,691.53 / $10,964.78
| Professional | | $489.78 | $2,691.53 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $19,054.61
| Facility | | $56.23 | $4,677.35 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $4,677.35 / $16,595.87
| Professional | | $549.54 | $4,677.35 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $1,348.96
| Facility | | $588.84 | $588.84 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $3,467.37 / $15,488.17
| Professional | | $691.83 | $3,467.37 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,479.11 / $15,488.17
| Professional | | $630.96 | $1,479.11 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $954.99 / $7,079.46
| Facility | | $457.09 | $954.99 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,511.38 / $12,302.69
| Professional | | $6,918.31 | $8,511.38 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $19,498.45
| Facility | | $2,570.40 | $6,918.31 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $6,025.60 / $14,791.08
| Professional | | $549.54 | $6,025.60 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,623.41 / $9,120.11
| Facility | | $3,715.35 | $5,623.41 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Professional | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $19,054.61
| Facility | | $56.23 | $4,677.35 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $4,677.35 / $16,595.87
| Professional | | $549.54 | $4,677.35 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $19,498.45
| Facility | | $2,570.40 | $7,244.36 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $4,786.30 / $15,135.61
| Professional | | $588.84 | $4,786.30 | $15,135.61 |