- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.38 / $271.83 / $518.29
| Facility | | $175.38 | $271.83 | $518.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.53 / $238.46 / $262.30
| Professional | | $187.53 | $238.46 | $262.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,865.03 / $6,710.89 / $14,325.16
| Facility | | $2,865.03 | $6,710.89 | $14,325.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.37 / $363.37 / $363.37
| Professional | | $363.37 | $363.37 | $363.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $232.62
| Facility | | $80.00 | $80.00 | $232.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.96 / $238.46 / $408.51
| Facility | | $224.96 | $238.46 | $408.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $238.46 / $238.46
| Professional | | $238.46 | $238.46 | $238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,492.28 / $10,081.35 / $10,081.35
| Facility | | $4,492.28 | $10,081.35 | $10,081.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,586.83 / $16,586.83 / $16,586.83
| Professional | | $16,586.83 | $16,586.83 | $16,586.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.38 / $181.30 / $683.60
| Facility | | $151.38 | $181.30 | $683.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $243.23 / $393.46
| Professional | | $238.46 | $243.23 | $393.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.62 / $274.22 / $565.39
| Professional | | $232.62 | $274.22 | $565.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.41 / $238.46 / $683.60
| Facility | | $153.41 | $238.46 | $683.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $238.46 / $450.67
| Professional | | $238.46 | $238.46 | $450.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $252.77 / $265.45
| Professional | | $238.46 | $252.77 | $265.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.64 / $238.46 / $333.84
| Professional | | $173.64 | $238.46 | $333.84 |