- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $891.25 / $1,412.54
| Facility | | $398.11 | $891.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $457.09
| Professional | | $281.84 | $363.08 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $1,202.26
| Facility | | $467.74 | $467.74 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $933.25
| Professional | | $281.84 | $281.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $467.74 / $467.74
| Professional | | $338.84 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,000.00 / $1,202.26
| Facility | | $302.00 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,862.09 / $2,238.72
| Professional | | $467.74 | $1,862.09 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $776.25 / $1,778.28
| Facility | | $467.74 | $776.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $912.01
| Professional | | $489.78 | $630.96 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $457.09 / $831.76
| Professional | | $398.11 | $457.09 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $50,118.72
| Facility | | $602.56 | $870.96 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $478.63
| Professional | | $467.74 | $467.74 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $467.74 / $562.34
| Facility | | $416.87 | $467.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $281.84 / $616.60
| Professional | | $194.98 | $281.84 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $467.74 / $537.03
| Facility | | $398.11 | $467.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $933.25
| Professional | | $316.23 | $467.74 | $933.25 |