- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.44 / $998.94 / $2,073.96
| Facility | | $245.44 | $998.94 | $2,073.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.44 / $245.44 / $245.44
| Professional | | $245.44 | $245.44 | $245.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.81 / $437.81 / $437.81
| Professional | | $437.81 | $437.81 | $437.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.00 / $614.00 / $1,379.50
| Facility | | $203.00 | $614.00 | $1,379.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.35 / $72.20 / $118.46
| Professional | | $63.35 | $72.20 | $118.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.53 / $1,627.20 / $1,982.77
| Facility | | $1,360.53 | $1,627.20 | $1,982.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.29 / $178.98 / $447.54
| Professional | | $125.29 | $178.98 | $447.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.66 / $461.77 / $921.75
| Facility | | $181.66 | $461.77 | $921.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.35 / $330.42 / $440.56
| Professional | | $275.35 | $330.42 | $440.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.82 / $316.64 / $525.91
| Professional | | $247.82 | $316.64 | $525.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.11 / $1,307.91 / $1,307.91
| Facility | | $479.11 | $1,307.91 | $1,307.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.24 / $1,371.24 / $2,065.13
| Professional | | $1,371.24 | $1,371.24 | $2,065.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.28 / $338.68 / $730.60
| Facility | | $220.28 | $338.68 | $730.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.35 / $302.89 / $413.03
| Professional | | $275.35 | $302.89 | $413.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.65 / $125.28 / $708.48
| Professional | | $115.65 | $125.28 | $708.48 |