- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.11 / $4,440.87 / $8,247.33
| Facility | | $230.11 | $4,440.87 | $8,247.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.11 / $248.51 / $460.21
| Professional | | $230.11 | $248.51 | $460.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.58 / $525.58 / $525.58
| Facility | | $525.58 | $525.58 | $525.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.61 / $420.61 / $420.61
| Facility | | $420.61 | $420.61 | $420.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.52 / $357.52 / $420.61
| Professional | | $357.52 | $357.52 | $420.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,275.37 / $2,499.78 / $2,499.78
| Facility | | $2,275.37 | $2,499.78 | $2,499.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,617.39 / $2,617.39 / $3,930.90
| Professional | | $2,617.39 | $2,617.39 | $3,930.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.43 / $366.27 / $525.58
| Facility | | $152.43 | $366.27 | $525.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.43 / $483.53 / $528.70
| Professional | | $152.43 | $483.53 | $528.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.60 / $187.60 / $187.60
| Professional | | $187.60 | $187.60 | $187.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.43 / $368.73 / $525.58
| Facility | | $152.43 | $368.73 | $525.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.52 / $357.52 / $420.61
| Professional | | $357.52 | $357.52 | $420.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.77 / $291.08 / $355.76
| Professional | | $196.77 | $291.08 | $355.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.26 / $286.39 / $525.58
| Professional | | $284.26 | $286.39 | $525.58 |