- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.91 / $1,555.95 / $2,061.69
| Facility | | $494.91 | $1,555.95 | $2,061.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.87 / $494.91 / $795.36
| Professional | | $464.87 | $494.91 | $795.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.39 / $806.83 / $2,118.12
| Facility | | $522.39 | $806.83 | $2,118.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.90 / $707.02 / $2,682.75
| Professional | | $405.90 | $707.02 | $2,682.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.26 / $1,550.98 / $2,809.75
| Facility | | $1,009.26 | $1,550.98 | $2,809.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.60 / $664.60 / $664.60
| Professional | | $664.60 | $664.60 | $664.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.56 / $527.67 / $1,539.06
| Facility | | $459.56 | $527.67 | $1,539.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.92 / $713.78 / $1,763.70
| Professional | | $358.92 | $713.78 | $1,763.70 |
- 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
- $975.96 / $975.96 / $1,148.19
| Professional | | $975.96 | $975.96 | $1,148.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.50 / $676.50 / $2,178.33
| Professional | | $676.50 | $676.50 | $2,178.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,177.10 / $3,213.38 / $3,213.38
| Facility | | $1,177.10 | $3,213.38 | $3,213.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.90 / $424.21 / $3,382.50
| Professional | | $405.90 | $424.21 | $3,382.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.13 / $405.90 / $1,208.27
| Professional | | $284.13 | $405.90 | $1,208.27 |