- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.83 / $2,151.91 / $3,174.55
| Facility | | $614.83 | $2,151.91 | $3,174.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $607.24 / $728.69
| Professional | | $455.43 | $607.24 | $728.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,771.17 / $3,692.72 / $8,459.92
| Facility | | $2,771.17 | $3,692.72 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.05 / $592.05 / $592.05
| Professional | | $592.05 | $592.05 | $592.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.38 / $1,121.25 / $2,220.21
| Facility | | $493.38 | $1,121.25 | $2,220.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.64 / $742.71 / $1,403.27
| Professional | | $357.64 | $742.71 | $1,403.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.16 / $607.24 / $1,282.79
| Professional | | $349.16 | $607.24 | $1,282.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.05 / $1,000.05 / $1,000.05
| Facility | | $1,000.05 | $1,000.05 | $1,000.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.50 / $561.50 / $561.50
| Professional | | $561.50 | $561.50 | $561.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.19 / $2,151.91 / $3,134.88
| Facility | | $645.19 | $2,151.91 | $3,134.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $614.83 / $3,134.88
| Professional | | $455.43 | $614.83 | $3,134.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.39 / $1,138.58 / $1,518.10
| Professional | | $1,123.39 | $1,138.58 | $1,518.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.18 / $1,262.81 / $2,518.75
| Facility | | $508.18 | $1,262.81 | $2,518.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.74 / $745.97 / $1,397.94
| Professional | | $370.74 | $745.97 | $1,397.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $882.56
| Facility | | $759.05 | $759.05 | $882.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $882.56
| Professional | | $759.05 | $759.05 | $882.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $455.43 / $1,243.60
| Professional | | $318.80 | $455.43 | $1,243.60 |