- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.21 / $1,246.46 / $1,470.82
| Facility | | $470.21 | $1,246.46 | $1,470.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.75 / $288.47 / $302.70
| Professional | | $188.75 | $288.47 | $302.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.77 / $277.77 / $277.77
| Professional | | $277.77 | $277.77 | $277.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.96 / $488.14 / $1,182.23
| Facility | | $337.96 | $488.14 | $1,182.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,716.55 / $1,716.55 / $1,716.55
| Professional | | $1,716.55 | $1,716.55 | $1,716.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.94 / $480.78 / $879.64
| Professional | | $373.94 | $480.78 | $879.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.09 / $1,470.82 / $1,470.82
| Facility | | $548.09 | $1,470.82 | $1,470.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.17 / $292.02 / $1,470.82
| Professional | | $242.17 | $292.02 | $1,470.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.07 / $534.20 / $712.26
| Professional | | $527.07 | $534.20 | $712.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.64 / $551.26 / $1,182.23
| Facility | | $346.64 | $551.26 | $1,182.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,716.55 / $1,716.55 / $1,716.55
| Professional | | $1,716.55 | $1,716.55 | $1,716.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.13 / $356.13 / $391.74
| Facility | | $356.13 | $356.13 | $391.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.13 / $356.13 / $391.74
| Professional | | $356.13 | $356.13 | $391.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.57 / $213.68 / $498.58
| Professional | | $149.57 | $213.68 | $498.58 |