- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.34 / $1,745.81 / $2,313.28
| Facility | | $531.34 | $1,745.81 | $2,313.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.08 / $531.34 / $614.83
| Professional | | $499.08 | $531.34 | $614.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.96 / $1,936.35 / $2,773.34
| Facility | | $834.96 | $1,936.35 | $2,773.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $759.05 / $3,010.11
| Professional | | $455.43 | $759.05 | $3,010.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.05 / $1,085.44 / $1,897.63
| Facility | | $759.05 | $1,085.44 | $1,897.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.35 / $548.44 / $1,726.83
| Facility | | $488.35 | $548.44 | $1,726.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.04 / $924.59 / $1,107.77
| Professional | | $444.04 | $924.59 | $1,107.77 |
- 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
- $1,095.45 / $1,095.45 / $1,288.77
| Professional | | $1,095.45 | $1,095.45 | $1,288.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $2,350.69
| Professional | | $759.05 | $759.05 | $2,350.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.75 / $3,605.49 / $3,605.49
| Facility | | $1,320.75 | $3,605.49 | $3,605.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $455.43 / $3,795.25
| Professional | | $455.43 | $455.43 | $3,795.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.43 / $455.43 / $455.43
| Facility | | $455.43 | $455.43 | $455.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $455.43 / $1,458.14
| Professional | | $455.43 | $455.43 | $1,458.14 |