- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $3,630.78 / $9,549.93
| Facility | | $269.15 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $263.03 / $478.63
| Professional | | $208.93 | $263.03 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $302.00 / $457.09
| Professional | | $223.87 | $302.00 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $251.19 / $346.74
| Professional | | $223.87 | $251.19 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $524.81 / $616.60
| Facility | | $489.78 | $524.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $288.40 / $478.63
| Professional | | $223.87 | $288.40 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $239.88 / $398.11
| Professional | | $199.53 | $239.88 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $338.84 / $457.09
| Professional | | $316.23 | $338.84 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $309.03 / $467.74
| Facility | | $229.09 | $309.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Professional | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $281.84 / $512.86
| Facility | | $229.09 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $281.84 / $512.86
| Professional | | $229.09 | $281.84 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,019.95 / $6,606.93
| Facility | | $407.38 | $3,019.95 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $269.15 / $457.09
| Professional | | $181.97 | $269.15 | $457.09 |