- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $851.14 / $2,630.27
| Facility | | $354.81 | $851.14 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $446.68 / $645.65
| Professional | | $346.74 | $446.68 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $2,630.27
| Facility | | $380.19 | $575.44 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $851.14
| Professional | | $707.95 | $707.95 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,365.16 / $4,365.16
| Professional | | $2,884.03 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $1,096.48
| Facility | | $407.38 | $588.84 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $467.74 / $707.95
| Professional | | $346.74 | $467.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $630.96 / $1,258.93
| Professional | | $588.84 | $630.96 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $1,621.81
| Facility | | $407.38 | $588.84 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $616.60 / $1,023.29
| Professional | | $79.43 | $616.60 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $245.47 / $588.84
| Facility | | $208.93 | $245.47 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $398.11
| Professional | | $245.47 | $245.47 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $588.84 / $588.84
| Professional | | $229.09 | $588.84 | $588.84 |