- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,248.07 / $13,182.57
| Facility | | $812.83 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $588.84 / $1,905.46
| Professional | | $380.19 | $588.84 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $724.44 / $1,122.02
| Professional | | $407.38 | $724.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $977.24
| Professional | | $630.96 | $851.14 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $645.65 / $7,244.36
| Facility | | $398.11 | $645.65 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $776.25 / $1,202.26
| Professional | | $616.60 | $776.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $794.33 / $831.76
| Facility | | $660.69 | $794.33 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $630.96 / $977.24
| Facility | | $398.11 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $776.25 / $1,096.48
| Professional | | $79.43 | $776.25 | $1,096.48 |
- 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
- $724.44 / $831.76 / $1,202.26
| Professional | | $724.44 | $831.76 | $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
- $537.03 / $794.33 / $1,096.48
| Professional | | $537.03 | $794.33 | $1,096.48 |