- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.52 / $431.52 / $431.52
| Facility | | $431.52 | $431.52 | $431.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.22 / $431.52 / $632.53
| Professional | | $336.22 | $431.52 | $632.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.82 / $2,553.73 / $4,711.96
| Facility | | $770.82 | $2,553.73 | $4,711.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.47 / $733.67 / $964.47
| Professional | | $409.47 | $733.67 | $964.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.38 / $1,275.33 / $1,642.39
| Facility | | $1,078.38 | $1,275.33 | $1,642.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.71 / $712.41 / $712.41
| Professional | | $646.71 | $712.41 | $712.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.11 / $710.11 / $725.90
| Facility | | $710.11 | $710.11 | $725.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.38 / $518.38 / $1,173.00
| Professional | | $518.38 | $518.38 | $1,173.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.63 / $799.63 / $839.61
| Professional | | $799.63 | $799.63 | $839.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.89 / $540.89 / $540.89
| Facility | | $540.89 | $540.89 | $540.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.92 / $572.99 / $572.99
| Professional | | $527.92 | $572.99 | $572.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,054.06 / $4,711.96 / $4,711.96
| Facility | | $2,054.06 | $4,711.96 | $4,711.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.81 / $492.71 / $964.47
| Professional | | $375.81 | $492.71 | $964.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.21 / $492.71 / $964.47
| Professional | | $382.21 | $492.71 | $964.47 |