- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $7,943.28 / $13,182.57
| Facility | | $707.95 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $602.56 / $1,995.26
| Professional | | $338.84 | $602.56 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $758.58 / $1,174.90
| Professional | | $389.05 | $758.58 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $645.65 / $870.96
| Professional | | $501.19 | $645.65 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $870.96 / $10,715.19
| Facility | | $416.87 | $870.96 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $1,047.13
| Professional | | $512.86 | $724.44 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $707.95 / $954.99
| Facility | | $588.84 | $707.95 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $645.65 / $1,148.15
| Facility | | $380.19 | $645.65 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $724.44 / $1,071.52
| Professional | | $79.43 | $724.44 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $15,848.93 / $19,054.61
| Facility | | $12,022.64 | $15,848.93 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $851.14 / $1,023.29
| Professional | | $691.83 | $851.14 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $13,182.57 / $26,302.68
| Facility | | $2,137.96 | $13,182.57 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $870.96 / $1,174.90
| Professional | | $549.54 | $870.96 | $1,174.90 |