- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,235.94 / $8,317.64
| Facility | | $281.84 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $363.08 / $741.31
| Professional | | $239.88 | $363.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $363.08 / $630.96
| Professional | | $245.47 | $363.08 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $3,548.13
| Professional | | $251.19 | $363.08 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $407.38 / $724.44
| Professional | | $257.04 | $407.38 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $562.34
| Professional | | $371.54 | $467.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $524.81 / $912.01
| Professional | | $416.87 | $524.81 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $407.38 / $676.08
| Facility | | $251.19 | $407.38 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $6,918.31
| Facility | | $245.47 | $331.13 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $6,918.31
| Professional | | $346.74 | $478.63 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,079.46 / $13,803.84
| Facility | | $3,630.78 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $363.08 / $660.69
| Professional | | $223.87 | $363.08 | $660.69 |