- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,348.96 / $2,187.76
| Facility | | $616.60 | $1,348.96 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $549.54 / $691.83
| Professional | | $295.12 | $549.54 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $229.09 / $1,023.29
| Professional | | $229.09 | $229.09 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $724.44 / $724.44
| Professional | | $524.81 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,148.15 / $2,691.53
| Facility | | $467.74 | $1,148.15 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,047.13 / $3,467.37
| Professional | | $724.44 | $1,047.13 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $933.25 / $2,630.27
| Facility | | $724.44 | $933.25 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $933.25 / $1,412.54
| Professional | | $758.58 | $933.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $707.95 / $1,288.25
| Professional | | $575.44 | $707.95 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $50,118.72
| Facility | | $933.25 | $1,348.96 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $741.31
| Professional | | $724.44 | $724.44 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $724.44 / $870.96
| Facility | | $645.65 | $724.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $954.99
| Professional | | $302.00 | $436.52 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $724.44 / $831.76
| Facility | | $436.52 | $724.44 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $1,412.54
| Professional | | $575.44 | $724.44 | $1,412.54 |