- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.47 / $462.83 / $462.83
| Facility | | $415.47 | $462.83 | $462.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.47 / $480.66 / $696.13
| Professional | | $415.47 | $480.66 | $696.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.73 / $572.73 / $2,591.98
| Facility | | $572.73 | $572.73 | $2,591.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.93 / $582.03 / $1,082.94
| Professional | | $424.93 | $582.03 | $1,082.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.51 / $477.31 / $1,067.93
| Professional | | $325.51 | $477.31 | $1,067.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.86 / $567.86 / $567.86
| Facility | | $567.86 | $567.86 | $567.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.59 / $579.14 / $1,198.88
| Professional | | $448.59 | $579.14 | $1,198.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.00 / $557.75 / $752.96
| Professional | | $363.00 | $557.75 | $752.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.69 / $567.44 / $1,210.00
| Professional | | $454.69 | $567.44 | $1,210.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.63 / $2,251.03 / $2,450.29
| Facility | | $1,150.63 | $2,251.03 | $2,450.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,139.86 / $3,624.69 / $4,041.08
| Professional | | $3,139.86 | $3,624.69 | $4,041.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.14 / $608.91 / $873.03
| Facility | | $464.14 | $608.91 | $873.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.39 / $648.53 / $1,252.93
| Professional | | $457.39 | $648.53 | $1,252.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,480.13 / $1,480.13 / $1,480.13
| Professional | | $1,480.13 | $1,480.13 | $1,480.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.00 / $450.68 / $619.69
| Professional | | $363.00 | $450.68 | $619.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.11 / $466.28 / $991.93
| Professional | | $353.11 | $466.28 | $991.93 |