- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,348.96 / $7,943.28
| Facility | | $1,023.29 | $1,348.96 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $537.03 / $1,445.44
| Professional | | $446.68 | $537.03 | $1,445.44 |
- 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
- $524.81 / $891.25 / $1,380.38
| Professional | | $524.81 | $891.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,071.52 / $1,258.93
| Professional | | $831.76 | $1,071.52 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $758.58 / $1,148.15
| Facility | | $501.19 | $758.58 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $870.96 / $1,348.96
| Professional | | $724.44 | $870.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $912.01 / $1,047.13
| Facility | | $676.08 | $912.01 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $758.58 / $1,096.48
| Facility | | $489.78 | $758.58 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $912.01 / $1,380.38
| Professional | | $79.43 | $912.01 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $10,232.93 / $12,302.69
| Facility | | $5,495.41 | $10,232.93 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $1,445.44
| Professional | | $776.25 | $1,047.13 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,754.40 / $14,125.38
| Facility | | $1,698.24 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $1,348.96
| Professional | | $602.56 | $912.01 | $1,348.96 |