- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,023.29 / $1,659.59
| Facility | | $457.09 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $302.00 / $426.58
| Professional | | $223.87 | $302.00 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $602.56 / $1,288.25
| Facility | | $363.08 | $602.56 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Professional | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $501.19 / $812.83
| Professional | | $398.11 | $501.19 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $707.95
| Professional | | $281.84 | $446.68 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $954.99 / $1,584.89
| Facility | | $436.52 | $954.99 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $309.03 / $1,096.48
| Professional | | $223.87 | $309.03 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Professional | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $407.38 / $416.87
| Facility | | $371.54 | $407.38 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $407.38 / $416.87
| Professional | | $371.54 | $407.38 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $446.68
| Facility | | $371.54 | $371.54 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $223.87 / $467.74
| Professional | | $158.49 | $223.87 | $467.74 |