- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,698.24 / $2,344.23
| Facility | | $537.03 | $1,698.24 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $724.44
| Professional | | $501.19 | $588.84 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,949.84 / $3,630.78
| Facility | | $794.33 | $1,949.84 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $2,238.72
| Professional | | $457.09 | $758.58 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $954.99 / $1,380.38
| Facility | | $758.58 | $954.99 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $588.84 / $1,230.27
| Facility | | $537.03 | $588.84 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $933.25 / $1,096.48
| Professional | | $446.68 | $933.25 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,288.25
| Professional | | $1,096.48 | $1,096.48 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $1,621.81
| Professional | | $758.58 | $758.58 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,949.84 / $3,630.78
| Facility | | $794.33 | $1,949.84 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $2,238.72
| Professional | | $457.09 | $758.58 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $912.01
| Facility | | $457.09 | $758.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $758.58 / $1,584.89
| Professional | | $457.09 | $758.58 | $1,584.89 |