- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.88 / $768.88 / $768.88
| Facility | | $768.88 | $768.88 | $768.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.40 / $602.29 / $768.88
| Professional | | $525.40 | $602.29 | $768.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $208.00 / $2,613.69
| Professional | | $208.00 | $208.00 | $2,613.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.73 / $640.73 / $975.04
| Facility | | $640.73 | $640.73 | $975.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.49 / $2,060.78 / $3,161.29
| Facility | | $1,763.49 | $2,060.78 | $3,161.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.63 / $835.78 / $1,960.64
| Professional | | $668.63 | $835.78 | $1,960.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.44 / $576.66 / $820.13
| Facility | | $384.44 | $576.66 | $820.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.44 / $640.73 / $3,043.47
| Facility | | $384.44 | $640.73 | $3,043.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.62 / $640.73 / $1,345.53
| Professional | | $371.62 | $640.73 | $1,345.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $85.00 / $320.37
| Professional | | $85.00 | $85.00 | $320.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.44 / $576.66 / $820.13
| Facility | | $384.44 | $576.66 | $820.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.78 / $1,527.95 / $2,179.10
| Professional | | $752.78 | $1,527.95 | $2,179.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.46 / $1,281.46 / $3,043.47
| Facility | | $1,281.46 | $1,281.46 | $3,043.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,364.75 / $1,364.75 / $1,364.75
| Professional | | $1,364.75 | $1,364.75 | $1,364.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,498.39 / $3,498.39 / $3,498.39
| Professional | | $3,498.39 | $3,498.39 | $3,498.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.37 / $384.44 / $1,345.53
| Professional | | $320.37 | $384.44 | $1,345.53 |