- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,096.48 / $6,606.93
| Facility | | $645.65 | $1,096.48 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $537.03 / $1,096.48
| Professional | | $426.58 | $537.03 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $977.24 / $1,348.96
| Professional | | $501.19 | $977.24 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $933.25 / $1,148.15
| Professional | | $630.96 | $933.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $776.25 / $1,318.26
| Facility | | $512.86 | $776.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $1,174.90
| Professional | | $676.08 | $794.33 | $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
- $501.19 / $676.08 / $1,047.13
| Facility | | $501.19 | $676.08 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $891.25 / $1,202.26
| Professional | | $79.43 | $891.25 | $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
- $812.83 / $933.25 / $1,258.93
| Professional | | $812.83 | $933.25 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $9,549.93 / $12,882.50
| Facility | | $1,995.26 | $9,549.93 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $851.14 / $1,230.27
| Professional | | $562.34 | $851.14 | $1,230.27 |