- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.38 / $1,824.53 / $2,009.41
| Facility | | $642.38 | $1,824.53 | $2,009.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.87 / $389.23 / $413.56
| Professional | | $257.87 | $389.23 | $413.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.50 / $379.50 / $379.50
| Professional | | $379.50 | $379.50 | $379.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.74 / $632.12 / $1,453.80
| Facility | | $325.74 | $632.12 | $1,453.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,345.12 / $2,345.12 / $2,345.12
| Professional | | $2,345.12 | $2,345.12 | $2,345.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.87 / $656.83 / $1,201.75
| Professional | | $510.87 | $656.83 | $1,201.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.79 / $2,009.41 / $2,009.41
| Facility | | $748.79 | $2,009.41 | $2,009.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.32 / $413.56 / $2,009.41
| Professional | | $319.32 | $413.56 | $2,009.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.08 / $729.81 / $973.08
| Professional | | $720.08 | $729.81 | $973.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.02 / $614.73 / $1,614.69
| Facility | | $339.02 | $614.73 | $1,614.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,345.12 / $2,345.12 / $2,345.12
| Professional | | $2,345.12 | $2,345.12 | $2,345.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.54 / $486.54 / $535.19
| Facility | | $486.54 | $486.54 | $535.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.54 / $486.54 / $535.19
| Professional | | $486.54 | $486.54 | $535.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.89 / $583.85 / $583.85
| Facility | | $437.89 | $583.85 | $583.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.35 / $291.92 / $649.63
| Professional | | $204.35 | $291.92 | $649.63 |