- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.26 / $1,458.73 / $1,743.10
| Facility | | $354.26 | $1,458.73 | $1,743.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.07 / $337.59 / $354.26
| Professional | | $250.07 | $337.59 | $354.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.08 / $325.08 / $325.08
| Professional | | $325.08 | $325.08 | $325.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.04 / $541.82 / $1,383.25
| Facility | | $279.04 | $541.82 | $1,383.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.88 / $2,008.88 / $2,008.88
| Professional | | $2,008.88 | $2,008.88 | $2,008.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.62 / $562.65 / $1,029.45
| Professional | | $437.62 | $562.65 | $1,029.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.08 / $1,438.13 / $1,743.10
| Facility | | $464.08 | $1,438.13 | $1,743.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.52 / $354.26 / $1,721.30
| Professional | | $273.52 | $354.26 | $1,721.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.83 / $625.16 / $833.56
| Professional | | $616.83 | $625.16 | $833.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.04 / $541.82 / $1,383.25
| Facility | | $279.04 | $541.82 | $1,383.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.88 / $2,008.88 / $2,008.88
| Professional | | $2,008.88 | $2,008.88 | $2,008.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.07 / $250.07 / $500.14
| Facility | | $250.07 | $250.07 | $500.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.05 / $250.07 / $583.49
| Professional | | $175.05 | $250.07 | $583.49 |