- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.94 / $2,128.59 / $2,543.50
| Facility | | $516.94 | $2,128.59 | $2,543.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.90 / $492.62 / $516.94
| Professional | | $364.90 | $492.62 | $516.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.37 / $474.37 / $474.37
| Professional | | $474.37 | $474.37 | $474.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.17 / $790.62 / $2,017.82
| Facility | | $407.17 | $790.62 | $2,017.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,931.38 / $2,931.38 / $2,931.38
| Professional | | $2,931.38 | $2,931.38 | $2,931.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.58 / $821.03 / $1,502.18
| Professional | | $638.58 | $821.03 | $1,502.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.19 / $2,098.56 / $2,543.50
| Facility | | $677.19 | $2,098.56 | $2,543.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.14 / $516.94 / $2,511.73
| Professional | | $399.14 | $516.94 | $2,511.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.09 / $912.25 / $1,216.33
| Professional | | $900.09 | $912.25 | $1,216.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.17 / $790.62 / $2,017.82
| Facility | | $407.17 | $790.62 | $2,017.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,931.38 / $2,931.38 / $2,931.38
| Professional | | $2,931.38 | $2,931.38 | $2,931.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.16 / $608.16 / $608.16
| Facility | | $608.16 | $608.16 | $608.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.16 / $608.16 / $608.16
| Professional | | $608.16 | $608.16 | $608.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.43 / $364.90 / $812.03
| Professional | | $255.43 | $364.90 | $812.03 |