- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $912.01 / $7,585.78
| Facility | | $323.59 | $912.01 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $323.59 / $691.83
| Professional | | $213.80 | $323.59 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Professional | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $891.25
| Professional | | $295.12 | $426.58 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $645.65 / $1,122.02
| Facility | | $338.84 | $645.65 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $407.38 / $724.44
| Professional | | $263.03 | $407.38 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $602.56
| Facility | | $223.87 | $354.81 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Professional | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $645.65 / $891.25
| Professional | | $295.12 | $645.65 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,778.28 / $5,888.44
| Facility | | $398.11 | $1,778.28 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $323.59 / $575.44
| Professional | | $218.78 | $323.59 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $19,498.45
| Facility | | $3,715.35 | $3,715.35 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,754.23
| Professional | | $2,398.83 | $2,398.83 | $2,754.23 |