- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.38 / $1,639.15 / $1,934.20
| Facility | | $482.38 | $1,639.15 | $1,934.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.21 / $379.35 / $398.08
| Professional | | $248.21 | $379.35 | $398.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.30 / $365.30 / $365.30
| Professional | | $365.30 | $365.30 | $365.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.44 / $641.59 / $1,553.84
| Facility | | $444.44 | $641.59 | $1,553.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,257.35 / $2,257.35 / $2,257.35
| Professional | | $2,257.35 | $2,257.35 | $2,257.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.75 / $632.25 / $1,156.78
| Professional | | $491.75 | $632.25 | $1,156.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.77 / $1,934.20 / $1,934.20
| Facility | | $720.77 | $1,934.20 | $1,934.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.36 / $398.08 / $1,934.20
| Professional | | $307.36 | $398.08 | $1,934.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.13 / $702.50 / $936.66
| Professional | | $693.13 | $702.50 | $936.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.90 / $725.01 / $1,553.84
| Facility | | $455.90 | $725.01 | $1,553.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,257.35 / $2,257.35 / $2,257.35
| Professional | | $2,257.35 | $2,257.35 | $2,257.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.33 / $468.33 / $515.16
| Facility | | $468.33 | $468.33 | $515.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.33 / $468.33 / $515.16
| Professional | | $468.33 | $468.33 | $515.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.70 / $281.00 / $655.66
| Professional | | $196.70 | $281.00 | $655.66 |