- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,548.82 / $2,511.89
| Facility | | $562.34 | $1,548.82 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $977.24
| Professional | | $354.81 | $478.63 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,884.03 / $5,011.87
| Facility | | $2,187.76 | $2,884.03 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $933.25 / $1,737.80
| Facility | | $398.11 | $933.25 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $645.65 / $1,348.96
| Professional | | $281.84 | $645.65 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $776.25 / $1,148.15
| Professional | | $281.84 | $776.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,047.13
| Professional | | $446.68 | $645.65 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $389.05 / $416.87
| Professional | | $354.81 | $389.05 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,479.11 / $2,511.89
| Facility | | $562.34 | $1,479.11 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $1,778.28
| Professional | | $354.81 | $512.86 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Professional | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $707.95 / $812.83
| Facility | | $288.40 | $707.95 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $707.95 / $812.83
| Professional | | $288.40 | $707.95 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $602.56 / $724.44
| Facility | | $302.00 | $602.56 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $794.33
| Professional | | $251.19 | $354.81 | $794.33 |