- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.59 / $1,707.22 / $2,262.14
| Facility | | $519.59 | $1,707.22 | $2,262.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.04 / $519.59 / $601.24
| Professional | | $488.04 | $519.59 | $601.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.50 / $1,723.55 / $3,525.78
| Facility | | $816.50 | $1,723.55 | $3,525.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.36 / $742.27 / $2,943.57
| Professional | | $445.36 | $742.27 | $2,943.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.85 / $661.88 / $1,157.13
| Facility | | $462.85 | $661.88 | $1,157.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.30 / $578.98 / $1,688.68
| Facility | | $487.30 | $578.98 | $1,688.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.45 / $904.45 / $1,083.64
| Professional | | $904.45 | $904.45 | $1,083.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.19 / $1,071.19 / $1,260.22
| Professional | | $1,071.19 | $1,071.19 | $1,260.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.27 / $742.27 / $1,541.55
| Professional | | $742.27 | $742.27 | $1,541.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.55 / $3,525.78 / $3,525.78
| Facility | | $1,291.55 | $3,525.78 | $3,525.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.36 / $445.36 / $3,711.35
| Professional | | $445.36 | $445.36 | $3,711.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.36 / $445.36 / $1,534.12
| Professional | | $445.36 | $445.36 | $1,534.12 |