- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,698.24 / $2,344.23
| Facility | | $524.81 | $1,698.24 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $707.95
| Professional | | $501.19 | $602.56 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $3,715.35
| Professional | | $446.68 | $446.68 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $1,202.26
| Facility | | $501.19 | $588.84 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,096.48
| Professional | | $912.01 | $912.01 | $1,096.48 |
- 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
- $758.58 / $758.58 / $1,202.26
| Professional | | $758.58 | $758.58 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $3,715.35
| Professional | | $446.68 | $446.68 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $758.58 / $891.25
| Facility | | $446.68 | $758.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $575.44 / $1,318.26
| Professional | | $446.68 | $575.44 | $1,318.26 |