- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.60 / $1,523.62 / $2,719.12
| Facility | | $645.60 | $1,523.62 | $2,719.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.65 / $622.80 / $683.58
| Professional | | $569.65 | $622.80 | $683.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.53 / $759.53 / $3,698.91
| Facility | | $759.53 | $759.53 | $3,698.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.81 / $303.81 / $464.07
| Professional | | $303.81 | $303.81 | $464.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.62 / $1,184.85 / $2,852.96
| Professional | | $607.62 | $1,184.85 | $2,852.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.21 / $1,413.42 / $3,891.65
| Facility | | $499.21 | $1,413.42 | $3,891.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.56 / $460.96 / $1,253.45
| Professional | | $347.56 | $460.96 | $1,253.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.53 / $911.44 / $1,124.09
| Professional | | $759.53 | $911.44 | $1,124.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.62 / $660.07 / $1,025.36
| Facility | | $607.62 | $660.07 | $1,025.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.78 / $816.00 / $1,793.93
| Professional | | $650.78 | $816.00 | $1,793.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.66 / $883.18 / $4,071.00
| Facility | | $531.66 | $883.18 | $4,071.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.66 / $883.18 / $4,071.00
| Professional | | $531.66 | $883.18 | $4,071.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.74 / $319.00 / $455.72
| Professional | | $49.74 | $319.00 | $455.72 |