- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,122.02 / $1,584.89
| Facility | | $354.81 | $1,122.02 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $380.19 / $489.78
| Professional | | $331.13 | $380.19 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,513.56 / $2,398.83
| Facility | | $524.81 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $501.19 / $1,047.13
| Professional | | $302.00 | $501.19 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,023.29 / $1,445.44
| Facility | | $812.83 | $1,023.29 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $389.05 / $812.83
| Facility | | $331.13 | $389.05 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $562.34 / $691.83
| Professional | | $524.81 | $562.34 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $851.14
| Professional | | $724.44 | $724.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $912.01
| Professional | | $501.19 | $501.19 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $575.44
| Facility | | $537.03 | $537.03 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,513.56 / $2,398.83
| Facility | | $524.81 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $501.19 / $1,047.13
| Professional | | $302.00 | $501.19 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $501.19 / $602.56
| Facility | | $251.19 | $501.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $380.19 / $602.56
| Professional | | $229.09 | $380.19 | $602.56 |