- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,180.24 / $1,227.18 / $1,820.32
| Facility | | $1,180.24 | $1,227.18 | $1,820.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.01 / $1,365.15 / $1,820.32
| Professional | | $1,084.01 | $1,365.15 | $1,820.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.68 / $322.68 / $655.20
| Facility | | $184.68 | $322.68 | $655.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.85 / $128.85 / $128.85
| Professional | | $128.85 | $128.85 | $128.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,323.90 / $2,323.90 / $2,323.90
| Facility | | $2,323.90 | $2,323.90 | $2,323.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.19 / $144.19 / $2,067.13
| Facility | | $144.19 | $144.19 | $2,067.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.56 / $144.19 / $211.75
| Professional | | $122.56 | $144.19 | $211.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,296.39 / $11,834.20 / $12,265.69
| Facility | | $4,296.39 | $11,834.20 | $12,265.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.79 / $808.16 / $1,783.33
| Facility | | $161.79 | $808.16 | $1,783.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.88 / $687.20 / $2,129.30
| Professional | | $181.88 | $687.20 | $2,129.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.19 / $808.16 / $1,737.18
| Facility | | $144.19 | $808.16 | $1,737.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.56 / $144.19 / $211.75
| Professional | | $122.56 | $144.19 | $211.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.99 / $856.32 / $1,547.47
| Professional | | $695.99 | $856.32 | $1,547.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.40 / $1,120.40 / $1,256.74
| Professional | | $1,120.40 | $1,120.40 | $1,256.74 |