- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $7,943.28 / $17,378.01
| Facility | | $870.96 | $7,943.28 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $549.54 / $1,479.11
| Professional | | $398.11 | $549.54 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $933.25 / $1,348.96
| Professional | | $512.86 | $933.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $891.25 / $1,148.15
| Professional | | $676.08 | $891.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $11,220.18
| Facility | | $524.81 | $776.25 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $758.58 / $1,202.26
| Professional | | $645.65 | $758.58 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $851.14 / $891.25
| Facility | | $676.08 | $851.14 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $645.65 / $1,071.52
| Facility | | $457.09 | $645.65 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $851.14 / $1,202.26
| Professional | | $79.43 | $851.14 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,912.51 / $10,715.19
| Facility | | $6,606.93 | $8,912.51 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $954.99 / $1,202.26
| Professional | | $812.83 | $954.99 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $9,549.93 / $12,882.50
| Facility | | $1,995.26 | $9,549.93 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $1,230.27
| Professional | | $588.84 | $851.14 | $1,230.27 |