- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.36 / $1,345.57 / $2,369.56
| Facility | | $590.36 | $1,345.57 | $2,369.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.52 / $556.41 / $719.33
| Professional | | $448.52 | $556.41 | $719.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.51 / $338.51 / $1,891.58
| Professional | | $338.51 | $338.51 | $1,891.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.08 / $1,188.17 / $2,955.48
| Facility | | $550.08 | $1,188.17 | $2,955.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.34 / $1,234.70 / $4,079.02
| Professional | | $812.34 | $1,234.70 | $4,079.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.70 / $332.00 / $1,904.11
| Facility | | $115.70 | $332.00 | $1,904.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.39 / $1,100.15 / $1,836.41
| Professional | | $592.39 | $1,100.15 | $1,836.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.33 / $846.27 / $1,534.54
| Professional | | $719.33 | $846.27 | $1,534.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.08 / $1,188.17 / $3,046.26
| Facility | | $550.08 | $1,188.17 | $3,046.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.08 / $922.43 / $1,946.42
| Professional | | $550.08 | $922.43 | $1,946.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $507.76 / $1,328.52
| Professional | | $355.43 | $507.76 | $1,328.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.27 / $973.19 / $973.19
| Facility | | $846.27 | $973.19 | $973.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.33 / $846.27 / $1,017.15
| Professional | | $719.33 | $846.27 | $1,017.15 |