- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.07 / $1,189.94 / $2,132.91
| Facility | | $522.07 | $1,189.94 | $2,132.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.65 / $449.03 / $636.13
| Professional | | $396.65 | $449.03 | $636.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $335.33 / $999.28
| Professional | | $335.33 | $335.33 | $999.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.39 / $748.39 / $748.39
| Facility | | $748.39 | $748.39 | $748.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.32 / $748.39 / $748.39
| Professional | | $546.32 | $748.39 | $748.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.07 / $1,580.96 / $1,942.21
| Facility | | $898.07 | $1,580.96 | $1,942.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.90 / $3,607.24 / $3,607.24
| Professional | | $911.90 | $3,607.24 | $3,607.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $898.07 / $1,683.88
| Facility | | $294.00 | $898.07 | $1,683.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.81 / $1,010.33 / $1,624.01
| Professional | | $785.81 | $1,010.33 | $1,624.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.13 / $748.39 / $1,357.05
| Professional | | $636.13 | $748.39 | $1,357.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.89 / $1,826.14 / $1,942.21
| Facility | | $685.89 | $1,826.14 | $1,942.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.45 / $815.75 / $1,721.30
| Professional | | $486.45 | $815.75 | $1,721.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.32 / $449.03 / $1,134.24
| Professional | | $314.32 | $449.03 | $1,134.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.39 / $860.63 / $860.63
| Facility | | $748.39 | $860.63 | $860.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.13 / $748.39 / $899.50
| Professional | | $636.13 | $748.39 | $899.50 |