- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,230.27 / $1,995.26
| Facility | | $660.69 | $1,230.27 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $467.74
| Professional | | $288.40 | $398.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Professional | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $660.69 / $1,445.44
| Facility | | $323.59 | $660.69 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Professional | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $660.69 / $1,047.13
| Professional | | $512.86 | $660.69 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Facility | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $812.83 / $1,230.27
| Professional | | $524.81 | $812.83 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,230.27 / $1,995.26
| Facility | | $691.83 | $1,230.27 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $1,230.27
| Professional | | $288.40 | $398.11 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $691.83
| Professional | | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $537.03 / $575.44
| Facility | | $478.63 | $537.03 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $478.63 / $575.44
| Professional | | $407.38 | $478.63 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $588.84
| Facility | | $489.78 | $489.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $602.56
| Professional | | $204.17 | $295.12 | $602.56 |