- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,258.93 / $2,089.30
| Facility | | $426.58 | $1,258.93 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $407.38 / $562.34
| Professional | | $331.13 | $407.38 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,398.83 / $5,011.87
| Facility | | $1,819.70 | $2,398.83 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Professional | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $776.25 / $1,737.80
| Facility | | $338.84 | $776.25 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $660.69
| Professional | | $524.81 | $524.81 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $295.12 / $724.44
| Professional | | $234.42 | $295.12 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $501.19 / $870.96
| Professional | | $426.58 | $501.19 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $741.31 / $891.25
| Facility | | $660.69 | $741.31 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,258.93 / $2,089.30
| Facility | | $691.83 | $1,258.93 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $407.38 / $1,258.93
| Professional | | $331.13 | $407.38 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $549.54 / $549.54
| Facility | | $501.19 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $524.81 / $645.65
| Professional | | $501.19 | $524.81 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $501.19 / $602.56
| Facility | | $275.42 | $501.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $302.00 / $758.58
| Professional | | $213.80 | $302.00 | $758.58 |