- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $338.84 / $436.52
| Professional | | $257.04 | $338.84 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,995.26 / $2,238.72
| Facility | | $1,412.54 | $1,995.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $38.02 / $38.02
| Professional | | $33.11 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $426.58 / $457.09
| Professional | | $354.81 | $426.58 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $707.95
| Facility | | $549.54 | $549.54 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $467.74
| Facility | | $354.81 | $354.81 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $354.81 / $467.74
| Professional | | $302.00 | $354.81 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,570.40 / $2,570.40
| Facility | | $851.14 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $457.09 / $707.95
| Facility | | $218.78 | $457.09 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $436.52 / $501.19
| Professional | | $263.03 | $436.52 | $501.19 |
- 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
- $218.78 / $436.52 / $707.95
| Facility | | $218.78 | $436.52 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $467.74
| Professional | | $302.00 | $302.00 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.70 / $218.78 / $389.05
| Facility | | $25.70 | $218.78 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $316.23 / $489.78
| Professional | | $229.09 | $316.23 | $489.78 |