- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,630.78 / $9,549.93
| Facility | | $812.83 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $776.25 / $1,096.48
| Professional | | $660.69 | $776.25 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,302.69 / $17,782.79
| Facility | | $9,772.37 | $12,302.69 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $794.33 / $1,122.02
| Professional | | $602.56 | $794.33 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $851.14 / $1,174.90
| Professional | | $691.83 | $851.14 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $851.14 / $1,479.11
| Professional | | $645.65 | $851.14 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $724.44 / $891.25
| Professional | | $602.56 | $724.44 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,071.52 / $1,479.11
| Professional | | $851.14 | $1,071.52 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $912.01 / $1,380.38
| Facility | | $691.83 | $912.01 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $7,413.10
| Facility | | $602.56 | $870.96 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $7,413.10
| Professional | | $602.56 | $870.96 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $870.96 / $1,445.44
| Professional | | $575.44 | $870.96 | $1,445.44 |