- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $13,182.57
| Facility | | $912.01 | $1,202.26 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $501.19 / $1,288.25
| Professional | | $416.87 | $501.19 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $831.76 / $1,258.93
| Professional | | $489.78 | $831.76 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $1,122.02
| Professional | | $724.44 | $954.99 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $1,122.02
| Facility | | $457.09 | $707.95 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $812.83 / $1,174.90
| Professional | | $691.83 | $812.83 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $870.96 / $933.25
| Facility | | $676.08 | $870.96 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $1,047.13
| Facility | | $457.09 | $707.95 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $851.14 / $1,230.27
| Professional | | $79.43 | $851.14 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $12,302.69
| Facility | | $7,762.47 | $10,232.93 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $933.25 / $1,318.26
| Professional | | $794.33 | $933.25 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $12,882.50 / $26,302.68
| Facility | | $2,137.96 | $12,882.50 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $1,230.27
| Professional | | $602.56 | $870.96 | $1,230.27 |