- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.84 / $336.84 / $2,582.64
| Facility | | $336.84 | $336.84 | $2,582.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.84 / $375.45 / $673.68
| Professional | | $336.84 | $375.45 | $673.68 |
- 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
- $366.15 / $366.15 / $366.15
| Professional | | $366.15 | $366.15 | $366.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.36 / $769.36 / $769.36
| Facility | | $769.36 | $769.36 | $769.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.71 / $451.71 / $451.71
| Facility | | $451.71 | $451.71 | $451.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.95 / $383.95 / $451.71
| Professional | | $383.95 | $383.95 | $451.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,676.21 / $4,535.59 / $4,535.59
| Facility | | $3,676.21 | $4,535.59 | $4,535.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,583.33 / $4,583.33 / $5,960.33
| Professional | | $4,583.33 | $4,583.33 | $5,960.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.05 / $536.17 / $769.36
| Facility | | $235.05 | $536.17 | $769.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.05 / $707.81 / $869.27
| Professional | | $235.05 | $707.81 | $869.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.05 / $514.07 / $769.36
| Facility | | $235.05 | $514.07 | $769.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.95 / $383.95 / $465.26
| Professional | | $383.95 | $383.95 | $465.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.41 / $448.84 / $548.57
| Professional | | $303.41 | $448.84 | $548.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.60 / $441.74 / $769.36
| Professional | | $441.60 | $441.74 | $769.36 |