- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,584.89 / $2,344.23
| Facility | | $691.83 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $933.25
| Professional | | $512.86 | $676.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $1,288.25
| Professional | | $338.84 | $338.84 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,174.90 / $3,019.95
| Facility | | $549.54 | $1,174.90 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $4,073.80
| Professional | | $851.14 | $1,230.27 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $851.14 / $1,905.46
| Facility | | $114.82 | $851.14 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,047.13 / $1,659.59
| Professional | | $588.84 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $831.76 / $1,513.56
| Professional | | $707.95 | $831.76 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,584.89 / $50,118.72
| Facility | | $1,096.48 | $1,584.89 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $870.96
| Professional | | $851.14 | $851.14 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $851.14 / $1,023.29
| Facility | | $758.58 | $851.14 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $1,122.02
| Professional | | $354.81 | $512.86 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $851.14 / $977.24
| Facility | | $724.44 | $851.14 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $851.14 / $1,659.59
| Professional | | $707.95 | $851.14 | $1,659.59 |