- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.72 / $1,398.79 / $1,853.46
| Facility | | $425.72 | $1,398.79 | $1,853.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.87 / $425.72 / $492.62
| Professional | | $399.87 | $425.72 | $492.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.99 / $1,551.44 / $2,222.07
| Facility | | $668.99 | $1,551.44 | $2,222.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.90 / $608.16 / $2,411.78
| Professional | | $364.90 | $608.16 | $2,411.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.26 / $474.37 / $1,383.59
| Facility | | $399.26 | $474.37 | $1,383.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.72 / $740.72 / $887.47
| Professional | | $740.72 | $740.72 | $887.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $877.49 / $877.49 / $1,032.33
| Professional | | $877.49 | $877.49 | $1,032.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.16 / $608.16 / $1,263.05
| Professional | | $608.16 | $608.16 | $1,263.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.22 / $2,888.81 / $2,888.81
| Facility | | $1,058.22 | $2,888.81 | $2,888.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.90 / $364.90 / $3,028.69
| Professional | | $364.90 | $364.90 | $3,028.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.35 / $608.16 / $729.80
| Facility | | $547.35 | $608.16 | $729.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.90 / $364.90 / $1,256.97
| Professional | | $364.90 | $364.90 | $1,256.97 |