- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $933.25 / $2,884.03
| Facility | | $416.87 | $933.25 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $489.78 / $1,071.52
| Professional | | $416.87 | $489.78 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,089.30 / $2,137.96
| Facility | | $1,047.13 | $2,089.30 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $239.88 / $512.86
| Professional | | $165.96 | $239.88 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $977.24 / $3,981.07
| Facility | | $69.18 | $977.24 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $54.95 / $141.25
| Professional | | $40.74 | $54.95 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $602.56 / $1,380.38
| Facility | | $281.84 | $602.56 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Professional | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $562.34
| Professional | | $331.13 | $416.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $457.09 / $724.44
| Professional | | $371.54 | $457.09 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,090.30 / $3,090.30
| Professional | | $2,089.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $501.19 / $1,023.29
| Facility | | $416.87 | $501.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $457.09 / $630.96
| Professional | | $416.87 | $457.09 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $5,011.87
| Professional | | $331.13 | $416.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $416.87 / $416.87
| Facility | | $173.78 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $186.21 / $912.01
| Professional | | $173.78 | $186.21 | $912.01 |