- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,174.90 / $2,691.53
| Facility | | $512.86 | $1,174.90 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $478.63 / $630.96
| Professional | | $363.08 | $478.63 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $630.96
| Professional | | $120.23 | $120.23 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $851.14 / $2,187.76
| Facility | | $389.05 | $851.14 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $2,884.03
| Professional | | $602.56 | $870.96 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $602.56 / $1,348.96
| Facility | | $257.04 | $602.56 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $1,174.90
| Professional | | $426.58 | $741.31 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $1,071.52
| Professional | | $501.19 | $588.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,148.15 / $50,118.72
| Facility | | $776.25 | $1,148.15 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $616.60
| Professional | | $602.56 | $602.56 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $602.56 / $724.44
| Facility | | $537.03 | $602.56 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $794.33
| Professional | | $251.19 | $363.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $602.56 / $691.83
| Facility | | $512.86 | $602.56 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $1,202.26
| Professional | | $501.19 | $602.56 | $1,202.26 |