- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,905.46 / $3,162.28
| Facility | | $645.65 | $1,905.46 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $380.19 / $489.78
| Professional | | $309.03 | $380.19 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,344.23 / $2,344.23
| Facility | | $1,174.90 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $3.24 / $707.95
| Professional | | $2.57 | $3.24 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,047.13 / $1,318.26
| Facility | | $338.84 | $1,047.13 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $346.74 / $851.14
| Professional | | $269.15 | $346.74 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $645.65 / $1,548.82
| Facility | | $316.23 | $645.65 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $562.34 / $707.95
| Professional | | $537.03 | $562.34 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $467.74 / $562.34
| Professional | | $100.00 | $467.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $812.83
| Professional | | $371.54 | $467.74 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $19.95 / $19.95
| Professional | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $524.81 / $1,174.90
| Facility | | $275.42 | $524.81 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $512.86
| Professional | | $354.81 | $467.74 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $794.33
| Professional | | $371.54 | $467.74 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $257.04 / $467.74
| Facility | | $194.98 | $257.04 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $208.93 / $831.76
| Professional | | $194.98 | $208.93 | $831.76 |