- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $645.65 / $2,041.74
| Facility | | $295.12 | $645.65 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $338.84 / $501.19
| Professional | | $269.15 | $338.84 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $831.76 / $1,995.26
| Facility | | $295.12 | $831.76 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $549.54 / $660.69
| Professional | | $239.88 | $549.54 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,388.44 / $3,388.44
| Professional | | $2,238.72 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $446.68 / $851.14
| Facility | | $316.23 | $446.68 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $363.08 / $562.34
| Professional | | $269.15 | $363.08 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $489.78 / $954.99
| Professional | | $446.68 | $489.78 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $1,258.93
| Facility | | $316.23 | $467.74 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $478.63 / $794.33
| Professional | | $239.88 | $478.63 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $190.55 / $446.68
| Facility | | $162.18 | $190.55 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $309.03
| Professional | | $190.55 | $190.55 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $446.68 / $446.68
| Professional | | $177.83 | $446.68 | $446.68 |