- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.43 / $1,345.27 / $1,782.54
| Facility | | $409.43 | $1,345.27 | $1,782.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.57 / $409.43 / $473.77
| Professional | | $384.57 | $409.43 | $473.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.39 / $1,358.14 / $2,778.28
| Facility | | $643.39 | $1,358.14 | $2,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $614.14 / $2,319.50
| Professional | | $350.94 | $614.14 | $2,319.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.90 / $836.41 / $1,462.25
| Facility | | $584.90 | $836.41 | $1,462.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.32 / $422.61 / $1,330.67
| Facility | | $376.32 | $422.61 | $1,330.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.27 / $712.27 / $853.38
| Professional | | $712.27 | $712.27 | $853.38 |
- 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
- $843.88 / $843.88 / $992.80
| Professional | | $843.88 | $843.88 | $992.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.90 / $584.90 / $1,811.38
| Professional | | $584.90 | $584.90 | $1,811.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.73 / $2,778.28 / $2,778.28
| Facility | | $1,017.73 | $2,778.28 | $2,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $350.94 / $2,924.50
| Professional | | $350.94 | $350.94 | $2,924.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $350.94 / $1,114.85
| Professional | | $350.94 | $350.94 | $1,114.85 |