- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.08 / $1,634.56 / $3,176.01
| Facility | | $649.08 | $1,634.56 | $3,176.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.05 / $573.10 / $660.50
| Professional | | $512.05 | $573.10 | $660.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.91 / $536.91 / $536.91
| Professional | | $536.91 | $536.91 | $536.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.44 / $691.58 / $1,206.55
| Facility | | $569.44 | $691.58 | $1,206.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.32 / $741.21 / $1,455.58
| Professional | | $435.32 | $741.21 | $1,455.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.23 / $915.31 / $1,268.30
| Professional | | $675.23 | $915.31 | $1,268.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,060.92 / $1,621.92 / $6,608.78
| Facility | | $1,060.92 | $1,621.92 | $6,608.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.97 / $717.97 / $717.97
| Professional | | $717.97 | $717.97 | $717.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $835.50 / $2,066.38 / $6,293.52
| Facility | | $835.50 | $2,066.38 | $6,293.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.45 / $577.57 / $666.40
| Professional | | $529.45 | $577.57 | $666.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.54 / $649.10 / $1,025.52
| Professional | | $628.54 | $649.10 | $1,025.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.45 / $691.58 / $1,005.46
| Facility | | $510.45 | $691.58 | $1,005.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.32 / $727.18 / $1,942.22
| Professional | | $435.32 | $727.18 | $1,942.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.79 / $647.79 / $687.50
| Facility | | $647.79 | $647.79 | $687.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.41 / $647.79 / $660.75
| Professional | | $558.41 | $647.79 | $660.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.32 / $1,428.12 / $1,803.00
| Facility | | $803.32 | $1,428.12 | $1,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.25 / $687.50 / $1,126.51
| Professional | | $531.25 | $687.50 | $1,126.51 |