- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,041.74 / $7,943.28
| Facility | | $346.74 | $2,041.74 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $389.05 / $741.31
| Professional | | $239.88 | $389.05 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $446.68 / $691.83
| Professional | | $288.40 | $446.68 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $1,737.80 / $2,754.23
| Professional | | $275.42 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $1,862.09
| Facility | | $467.74 | $467.74 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $436.52 / $741.31
| Professional | | $288.40 | $436.52 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $501.19 / $588.84
| Professional | | $380.19 | $501.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $575.44
| Professional | | $537.03 | $537.03 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $407.38 / $616.60
| Facility | | $257.04 | $407.38 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Professional | | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $389.05 / $4,073.80
| Facility | | $269.15 | $389.05 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $549.54 / $4,073.80
| Professional | | $371.54 | $549.54 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,230.27 / $2,511.89
| Facility | | $229.09 | $1,230.27 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $398.11 / $676.08
| Professional | | $245.47 | $398.11 | $676.08 |