- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $5,128.61 / $15,848.93
| Facility | | $616.60 | $5,128.61 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $426.58 / $1,071.52
| Professional | | $323.59 | $426.58 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $891.25 / $1,258.93
| Professional | | $436.52 | $891.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $794.33 / $1,023.29
| Professional | | $537.03 | $794.33 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $616.60 / $1,513.56
| Facility | | $398.11 | $616.60 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $660.69 / $1,148.15
| Professional | | $562.34 | $660.69 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $741.31 / $891.25
| Facility | | $537.03 | $741.31 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $537.03 / $870.96
| Facility | | $398.11 | $537.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $794.33 / $1,122.02
| Professional | | $79.43 | $794.33 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,772.37 / $11,748.98
| Facility | | $7,079.46 | $9,772.37 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $891.25 / $1,202.26
| Professional | | $707.95 | $891.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $9,772.37 / $14,125.38
| Facility | | $1,995.26 | $9,772.37 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $741.31 / $1,122.02
| Professional | | $467.74 | $741.31 | $1,122.02 |