- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.83 / $348.60 / $2,429.63
| Facility | | $259.83 | $348.60 | $2,429.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.60 / $376.49 / $697.20
| Professional | | $348.60 | $376.49 | $697.20 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $378.93 / $378.93 / $378.93
| Professional | | $378.93 | $378.93 | $378.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.22 / $796.22 / $796.22
| Facility | | $796.22 | $796.22 | $796.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.54 / $502.54 / $502.54
| Facility | | $502.54 | $502.54 | $502.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.16 / $427.16 / $502.54
| Professional | | $427.16 | $427.16 | $502.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,658.96 / $3,746.76 / $3,746.76
| Facility | | $3,658.96 | $3,746.76 | $3,746.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,664.72 / $4,664.72 / $6,240.45
| Professional | | $4,664.72 | $4,664.72 | $6,240.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.26 / $554.89 / $796.22
| Facility | | $226.26 | $554.89 | $796.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.82 / $732.52 / $796.22
| Professional | | $228.82 | $732.52 | $796.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.60 / $514.60 / $514.60
| Professional | | $514.60 | $514.60 | $514.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.26 / $532.01 / $796.22
| Facility | | $226.26 | $532.01 | $796.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.16 / $427.16 / $517.62
| Professional | | $427.16 | $427.16 | $517.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.07 / $432.06 / $540.07
| Professional | | $292.07 | $432.06 | $540.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.10 / $428.25 / $796.22
| Professional | | $425.10 | $428.25 | $796.22 |