- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,479.11 / $2,187.76
| Facility | | $645.65 | $1,479.11 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $758.58
| Professional | | $426.58 | $616.60 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $537.03 / $1,174.90
| Professional | | $37.15 | $537.03 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,096.48 / $2,818.38
| Facility | | $512.86 | $1,096.48 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $3,801.89 / $3,801.89
| Professional | | $794.33 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,288.25 / $3,019.95
| Facility | | $794.33 | $1,288.25 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $977.24 / $1,513.56
| Professional | | $549.54 | $977.24 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $776.25 / $1,412.54
| Professional | | $676.08 | $776.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,479.11 / $50,118.72
| Facility | | $1,023.29 | $1,479.11 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $812.83
| Professional | | $794.33 | $794.33 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $794.33 / $954.99
| Facility | | $707.95 | $794.33 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $1,047.13
| Professional | | $331.13 | $467.74 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $912.01
| Facility | | $676.08 | $794.33 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $794.33 / $1,548.82
| Professional | | $537.03 | $794.33 | $1,548.82 |