- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,148.15 / $7,943.28
| Facility | | $676.08 | $1,148.15 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $489.78 / $1,096.48
| Professional | | $398.11 | $489.78 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $812.83 / $1,288.25
| Professional | | $478.63 | $812.83 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,071.52 / $1,288.25
| Professional | | $831.76 | $1,071.52 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $1,096.48
| Facility | | $457.09 | $691.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $831.76 / $1,230.27
| Professional | | $707.95 | $831.76 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $891.25 / $977.24
| Facility | | $645.65 | $891.25 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $1,023.29
| Facility | | $446.68 | $691.83 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $870.96 / $1,258.93
| Professional | | $79.43 | $870.96 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,011.87 / $6,165.95
| Facility | | $3,801.89 | $5,011.87 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $933.25 / $1,318.26
| Professional | | $741.31 | $933.25 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $8,128.31 / $12,882.50
| Facility | | $1,995.26 | $8,128.31 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $1,230.27
| Professional | | $575.44 | $851.14 | $1,230.27 |