- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,659.59 / $2,290.87
| Facility | | $524.81 | $1,659.59 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $691.83
| Professional | | $489.78 | $575.44 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,819.70 / $3,548.13
| Facility | | $812.83 | $1,819.70 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $741.31 / $2,818.38
| Professional | | $446.68 | $741.31 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $575.44 / $831.76
| Facility | | $467.74 | $575.44 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $575.44 / $1,202.26
| Facility | | $501.19 | $575.44 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,071.52
| Professional | | $912.01 | $912.01 | $1,071.52 |
- 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
- $1,071.52 / $1,071.52 / $1,258.93
| Professional | | $1,071.52 | $1,071.52 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $1,202.26
| Professional | | $741.31 | $741.31 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,819.70 / $3,548.13
| Facility | | $812.83 | $1,819.70 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $741.31 / $2,818.38
| Professional | | $446.68 | $741.31 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $741.31 / $891.25
| Facility | | $446.68 | $741.31 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $575.44 / $1,288.25
| Professional | | $446.68 | $575.44 | $1,288.25 |