- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,096.48 / $1,778.28
| Facility | | $588.84 | $1,096.48 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $512.86 / $1,071.52
| Professional | | $389.05 | $512.86 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $1,513.56
| Facility | | $588.84 | $588.84 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $1,318.26
| Professional | | $288.40 | $288.40 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $588.84
| Facility | | $354.81 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $588.84 / $588.84
| Professional | | $426.58 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,258.93 / $2,089.30
| Facility | | $389.05 | $1,258.93 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $851.14 / $2,818.38
| Professional | | $398.11 | $851.14 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $954.99 / $2,238.72
| Facility | | $588.84 | $954.99 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $1,122.02
| Professional | | $407.38 | $575.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $1,047.13
| Professional | | $501.19 | $588.84 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,096.48 / $50,118.72
| Facility | | $758.58 | $1,096.48 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $741.31
| Professional | | $588.84 | $588.84 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $588.84 / $707.95
| Facility | | $524.81 | $588.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $851.14
| Professional | | $245.47 | $354.81 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $616.60 / $933.25
| Facility | | $501.19 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $1,148.15
| Professional | | $501.19 | $588.84 | $1,148.15 |