- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,513.56 / $2,454.71
| Facility | | $549.54 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $549.54 / $2,570.40
| Professional | | $426.58 | $549.54 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $812.83 / $2,754.23
| Facility | | $524.81 | $812.83 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $575.44 / $1,412.54
| Professional | | $245.47 | $575.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,412.54 / $2,290.87
| Facility | | $1,148.15 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $741.31
| Professional | | $549.54 | $549.54 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $912.01 / $2,238.72
| Facility | | $457.09 | $912.01 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $707.95 / $1,318.26
| Professional | | $398.11 | $707.95 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $3,801.89 / $9,772.37
| Facility | | $83.18 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $977.24
| Professional | | $831.76 | $831.76 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,778.28
| Professional | | $575.44 | $575.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $812.83 / $2,754.23
| Facility | | $524.81 | $812.83 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $575.44 / $1,412.54
| Professional | | $275.42 | $575.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $954.99
| Facility | | $331.13 | $575.44 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $489.78 / $1,380.38
| Professional | | $190.55 | $489.78 | $1,380.38 |