- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.50 / $1,123.39 / $3,423.32
| Facility | | $713.50 | $1,123.39 | $3,423.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.34 / $570.79 / $786.45
| Professional | | $531.34 | $570.79 | $786.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $455.43 / $455.43
| Professional | | $455.43 | $455.43 | $455.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.00 / $1,245.59 / $3,605.49
| Facility | | $797.00 | $1,245.59 | $3,605.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $797.00 / $3,795.25
| Professional | | $500.00 | $797.00 | $3,795.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.10 / $789.41 / $1,959.95
| Facility | | $663.10 | $789.41 | $1,959.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.45 / $872.26 / $1,090.32
| Professional | | $406.45 | $872.26 | $1,090.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.96 / $958.95 / $2,347.71
| Facility | | $748.96 | $958.95 | $2,347.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.05 / $1,115.80 / $2,100.41
| Professional | | $759.05 | $1,115.80 | $2,100.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.44 / $743.10 / $805.48
| Professional | | $540.44 | $743.10 | $805.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $1,594.01
| Facility | | $759.05 | $759.05 | $1,594.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.00 / $1,138.57 / $2,087.39
| Facility | | $795.00 | $1,138.57 | $2,087.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.15 / $910.86 / $1,077.84
| Professional | | $683.15 | $910.86 | $1,077.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.00 / $1,245.59 / $2,087.39
| Facility | | $797.00 | $1,245.59 | $2,087.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.28 / $1,334.94 / $1,859.20
| Professional | | $687.28 | $1,334.94 | $1,859.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $336.98 / $850.14
| Professional | | $318.80 | $336.98 | $850.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.57 / $341.57 / $393.19
| Professional | | $341.57 | $341.57 | $393.19 |