- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.62 / $1,303.79 / $2,112.92
| Facility | | $405.62 | $1,303.79 | $2,112.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.66 / $405.62 / $681.27
| Professional | | $383.66 | $405.62 | $681.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.14 / $662.63 / $2,752.44
| Facility | | $428.14 | $662.63 | $2,752.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.84 / $347.68 / $1,014.06
| Professional | | $173.84 | $347.68 | $1,014.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.11 / $1,393.64 / $2,302.78
| Facility | | $921.11 | $1,393.64 | $2,302.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.65 / $708.10 / $1,318.28
| Facility | | $376.65 | $708.10 | $1,318.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.14 / $665.76 / $2,586.00
| Professional | | $278.14 | $665.76 | $2,586.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,472.00 / $9,239.00
| Facility | | $83.43 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.94 / $835.94 / $983.46
| Professional | | $835.94 | $835.94 | $983.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.46 / $803.13 / $1,865.86
| Professional | | $579.46 | $803.13 | $1,865.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.26 / $2,752.44 / $2,752.44
| Facility | | $1,008.26 | $2,752.44 | $2,752.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.84 / $347.68 / $1,014.06
| Professional | | $173.84 | $347.68 | $1,014.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.81 / $347.68 / $869.19
| Professional | | $202.81 | $347.68 | $869.19 |