- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $851.14 / $1,174.90
| Facility | | $263.03 | $851.14 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $302.00 / $354.81
| Professional | | $251.19 | $302.00 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $977.24 / $1,778.28
| Facility | | $398.11 | $977.24 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $371.54 / $1,096.48
| Professional | | $223.87 | $371.54 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $676.08
| Facility | | $371.54 | $467.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Professional | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $295.12 / $602.56
| Facility | | $263.03 | $295.12 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $416.87 / $501.19
| Professional | | $218.78 | $416.87 | $501.19 |
- 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
- $537.03 / $537.03 / $630.96
| Professional | | $537.03 | $537.03 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $602.56
| Professional | | $371.54 | $371.54 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $977.24 / $1,778.28
| Facility | | $398.11 | $977.24 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $371.54 / $1,096.48
| Professional | | $223.87 | $371.54 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $446.68
| Facility | | $223.87 | $223.87 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $302.00 / $660.69
| Professional | | $223.87 | $302.00 | $660.69 |