- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.80 / $4,778.89 / $13,841.56
| Facility | | $402.80 | $4,778.89 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.67 / $402.80 / $1,508.99
| Professional | | $266.67 | $402.80 | $1,508.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.35 / $6,198.03 / $11,988.99
| Facility | | $4,712.35 | $6,198.03 | $11,988.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.19 / $533.75 / $821.51
| Professional | | $284.19 | $533.75 | $821.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.43 / $395.43 / $395.43
| Facility | | $395.43 | $395.43 | $395.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.91 / $830.72 / $1,250.46
| Professional | | $539.91 | $830.72 | $1,250.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.81 / $506.67 / $1,354.04
| Facility | | $316.81 | $506.67 | $1,354.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.10 / $899.86 / $2,160.56
| Professional | | $542.10 | $899.86 | $2,160.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.48 / $736.97 / $1,158.96
| Facility | | $442.48 | $736.97 | $1,158.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.51 / $809.29 / $1,158.96
| Professional | | $586.51 | $809.29 | $1,158.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.69 / $534.75 / $870.75
| Professional | | $306.69 | $534.75 | $870.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.10 / $889.45 / $1,167.59
| Professional | | $542.10 | $889.45 | $1,167.59 |