- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.04 / $1,426.01 / $1,682.69
| Facility | | $627.04 | $1,426.01 | $1,682.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.94 / $244.46 / $321.87
| Professional | | $215.94 | $244.46 | $321.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.80 / $317.80 / $317.80
| Professional | | $317.80 | $317.80 | $317.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.65 / $558.14 / $1,351.74
| Facility | | $386.65 | $558.14 | $1,351.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,963.81 / $1,963.81 / $1,963.81
| Professional | | $1,963.81 | $1,963.81 | $1,963.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.80 / $550.03 / $1,006.35
| Professional | | $427.80 | $550.03 | $1,006.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,107.88 / $1,682.69 / $1,682.69
| Facility | | $1,107.88 | $1,682.69 | $1,682.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.46 / $1,405.89 / $1,682.69
| Professional | | $244.46 | $1,405.89 | $1,682.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.00 / $611.14 / $814.86
| Professional | | $603.00 | $611.14 | $814.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.70 / $630.88 / $1,351.74
| Facility | | $396.70 | $630.88 | $1,351.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,963.81 / $1,963.81 / $1,963.81
| Professional | | $1,963.81 | $1,963.81 | $1,963.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.43 / $407.43 / $448.17
| Facility | | $407.43 | $407.43 | $448.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.43 / $407.43 / $448.17
| Professional | | $407.43 | $407.43 | $448.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.12 / $244.46 / $611.15
| Professional | | $171.12 | $244.46 | $611.15 |