- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.69 / $1,979.51 / $2,308.88
| Facility | | $448.69 | $1,979.51 | $2,308.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.72 / $427.57 / $448.69
| Professional | | $316.72 | $427.57 | $448.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.74 / $411.74 / $411.74
| Professional | | $411.74 | $411.74 | $411.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.41 / $685.83 / $1,577.32
| Facility | | $353.41 | $685.83 | $1,577.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,544.33 / $2,544.33 / $2,544.33
| Professional | | $2,544.33 | $2,544.33 | $2,544.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.26 / $712.62 / $1,303.83
| Professional | | $554.26 | $712.62 | $1,303.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.78 / $1,979.51 / $2,308.88
| Facility | | $587.78 | $1,979.51 | $2,308.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.44 / $448.69 / $2,180.10
| Professional | | $346.44 | $448.69 | $2,180.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.25 / $791.80 / $1,055.74
| Professional | | $781.25 | $791.80 | $1,055.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.82 / $667.05 / $1,751.61
| Facility | | $367.82 | $667.05 | $1,751.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,544.33 / $2,544.33 / $2,544.33
| Professional | | $2,544.33 | $2,544.33 | $2,544.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.87 / $527.87 / $580.66
| Facility | | $527.87 | $527.87 | $580.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.87 / $527.87 / $580.66
| Professional | | $527.87 | $527.87 | $580.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.71 / $316.72 / $791.81
| Professional | | $221.71 | $316.72 | $791.81 |