- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $2,630.27
| Facility | | $338.84 | $338.84 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $426.58 / $676.08
| Professional | | $338.84 | $426.58 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,128.31 / $23,442.29
| Facility | | $4,466.84 | $8,128.31 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $851.14 / $1,348.96
| Professional | | $562.34 | $851.14 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,380.38 / $3,235.94
| Facility | | $977.24 | $1,380.38 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Facility | 22 | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,174.90 / $1,737.80
| Professional | | $758.58 | $1,174.90 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,318.26 / $2,570.40
| Facility | | $1,047.13 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $977.24 / $1,479.11
| Professional | | $707.95 | $977.24 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $851.14 / $6,760.83
| Facility | | $436.52 | $851.14 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $776.25 / $1,513.56
| Professional | | $457.09 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $8,912.51
| Facility | | $1,584.89 | $4,265.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $741.31 / $1,412.54
| Professional | | $407.38 | $741.31 | $1,412.54 |