- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.55 / $1,336.63 / $2,395.85
| Facility | | $714.55 | $1,336.63 | $2,395.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.88 / $504.38 / $840.65
| Professional | | $321.88 | $504.38 | $840.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.65 / $840.65 / $2,185.69
| Facility | | $840.65 | $840.65 | $2,185.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.26 / $336.26 / $1,202.14
| Professional | | $336.26 | $336.26 | $1,202.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.39 / $840.65 / $840.65
| Facility | | $504.39 | $840.65 | $840.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.66 / $840.65 / $840.65
| Professional | | $613.66 | $840.65 | $840.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.78 / $1,702.25 / $2,243.82
| Facility | | $1,008.78 | $1,702.25 | $2,243.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.20 / $1,020.40 / $2,727.72
| Professional | | $510.20 | $1,020.40 | $2,727.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.91 / $332.00 / $1,891.46
| Facility | | $130.91 | $332.00 | $1,891.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.70 / $672.52 / $1,538.39
| Professional | | $386.70 | $672.52 | $1,538.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.61 / $798.62 / $989.44
| Professional | | $390.61 | $798.62 | $989.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,781.58 / $3,781.58 / $3,781.58
| Facility | | $3,781.58 | $3,781.58 | $3,781.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.50 / $1,775.87 / $2,243.82
| Facility | | $254.50 | $1,775.87 | $2,243.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.72 / $826.85 / $2,306.10
| Professional | | $264.72 | $826.85 | $2,306.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.89 / $504.39 / $1,303.01
| Professional | | $331.89 | $504.39 | $1,303.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.04 / $891.09 / $891.09
| Facility | | $793.04 | $891.09 | $891.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.12 / $798.62 / $989.44
| Professional | | $379.12 | $798.62 | $989.44 |