- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.01 / $1,687.49 / $1,991.24
| Facility | | $742.01 | $1,687.49 | $1,991.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.87 / $124.39 / $136.06
| Professional | | $109.87 | $124.39 | $136.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.07 / $376.07 / $376.07
| Professional | | $376.07 | $376.07 | $376.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.47 / $642.04 / $1,599.48
| Facility | | $393.47 | $642.04 | $1,599.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.91 / $2,323.91 / $2,323.91
| Professional | | $2,323.91 | $2,323.91 | $2,323.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.25 / $650.89 / $1,190.89
| Professional | | $506.25 | $650.89 | $1,190.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.04 / $1,991.24 / $1,991.24
| Facility | | $1,311.04 | $1,991.24 | $1,991.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.39 / $1,991.24 / $1,991.24
| Professional | | $124.39 | $1,991.24 | $1,991.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.57 / $723.21 / $964.28
| Professional | | $713.57 | $723.21 | $964.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.47 / $642.04 / $1,599.48
| Facility | | $393.47 | $642.04 | $1,599.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.91 / $2,323.91 / $2,323.91
| Professional | | $2,323.91 | $2,323.91 | $2,323.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.14 / $482.14 / $530.35
| Facility | | $482.14 | $482.14 | $530.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.14 / $482.14 / $530.35
| Professional | | $482.14 | $482.14 | $530.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.50 / $202.50 / $202.50
| Facility | | $202.50 | $202.50 | $202.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.07 / $152.68 / $476.81
| Professional | | $87.07 | $152.68 | $476.81 |