- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,174.90 / $7,943.28
| Facility | | $630.96 | $1,174.90 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $1,445.44
| Professional | | $478.63 | $630.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $977.24 / $1,412.54
| Professional | | $645.65 | $977.24 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $977.24 / $1,202.26
| Professional | | $446.68 | $977.24 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $691.83 / $1,659.59
| Facility | | $630.96 | $691.83 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $1,513.56
| Professional | | $741.31 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $912.01 / $977.24
| Facility | | $776.25 | $912.01 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $660.69 / $1,174.90
| Facility | | $537.03 | $660.69 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $912.01 / $1,318.26
| Professional | | $79.43 | $912.01 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,122.02 / $1,513.56
| Professional | | $891.25 | $1,122.02 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,232.93 / $37,153.52
| Facility | | $2,454.71 | $10,232.93 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,023.29 / $1,412.54
| Professional | | $691.83 | $1,023.29 | $1,412.54 |