- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.30 / $1,274.58 / $2,284.62
| Facility | | $649.30 | $1,274.58 | $2,284.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.72 / $297.30 / $801.62
| Professional | | $244.72 | $297.30 | $801.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.62 / $801.62 / $2,084.21
| Facility | | $801.62 | $801.62 | $2,084.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.35 / $320.64 / $1,082.19
| Professional | | $160.35 | $320.64 | $1,082.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.97 / $801.62 / $801.62
| Facility | | $480.97 | $801.62 | $801.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.17 / $801.62 / $801.62
| Professional | | $585.17 | $801.62 | $801.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.15 / $1,623.11 / $3,542.33
| Facility | | $560.15 | $1,623.11 | $3,542.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.33 / $501.64 / $3,863.81
| Professional | | $212.33 | $501.64 | $3,863.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.69 / $346.00 / $1,803.65
| Facility | | $160.69 | $346.00 | $1,803.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.64 / $472.96 / $1,466.96
| Professional | | $320.64 | $472.96 | $1,466.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.70 / $541.55 / $900.30
| Professional | | $297.70 | $541.55 | $900.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.50 / $1,693.41 / $3,335.53
| Facility | | $386.50 | $1,693.41 | $3,335.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.19 / $501.64 / $1,242.51
| Professional | | $242.19 | $501.64 | $1,242.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.51 / $360.73 / $1,177.35
| Professional | | $252.51 | $360.73 | $1,177.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.73 / $921.84 / $1,214.06
| Facility | | $894.73 | $921.84 | $1,214.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.70 / $437.48 / $963.48
| Professional | | $297.70 | $437.48 | $963.48 |