- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,202.26 / $13,182.57
| Facility | | $630.96 | $1,202.26 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $489.78 / $1,659.59
| Professional | | $295.12 | $489.78 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $2,398.83
| Facility | | $1,659.59 | $1,659.59 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $691.83 / $1,174.90
| Professional | | $346.74 | $691.83 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $1,258.93
| Professional | | $575.44 | $812.83 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $588.84 / $1,047.13
| Facility | | $346.74 | $588.84 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,174.90
| Professional | | $512.86 | $741.31 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $954.99
| Facility | | $602.56 | $891.25 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $977.24
| Facility | | $331.13 | $562.34 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $812.83 / $1,202.26
| Professional | | $79.43 | $812.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,912.51 / $10,715.19
| Facility | | $6,606.93 | $8,912.51 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $1,230.27
| Professional | | $602.56 | $870.96 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $9,120.11 / $12,882.50
| Facility | | $1,621.81 | $9,120.11 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $741.31 / $1,202.26
| Professional | | $436.52 | $741.31 | $1,202.26 |