- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,096.48 / $7,943.28
| Facility | | $831.76 | $1,096.48 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $457.09 / $1,148.15
| Professional | | $363.08 | $457.09 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $2,290.87
| Facility | | $1,096.48 | $1,096.48 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $741.31 / $1,122.02
| Professional | | $346.74 | $741.31 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $1,023.29
| Professional | | $630.96 | $851.14 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $588.84 / $954.99
| Facility | | $416.87 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $741.31 / $1,071.52
| Professional | | $588.84 | $741.31 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $851.14
| Facility | | $588.84 | $776.25 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $977.24
| Facility | | $407.38 | $588.84 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $812.83 / $1,148.15
| Professional | | $79.43 | $812.83 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,715.35 / $4,677.35
| Facility | | $2,818.38 | $3,715.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $891.25 / $1,148.15
| Professional | | $758.58 | $891.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,897.79 / $7,244.36
| Facility | | $1,548.82 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $776.25 / $1,174.90
| Professional | | $446.68 | $776.25 | $1,174.90 |