- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.84 / $946.73 / $1,541.82
| Facility | | $459.84 | $946.73 | $1,541.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.83 / $294.83 / $459.84
| Professional | | $294.83 | $294.83 | $459.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $568.04
| Professional | | $50.00 | $50.00 | $568.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.99 / $540.99 / $540.99
| Facility | | $540.99 | $540.99 | $540.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.92 / $540.99 / $540.99
| Professional | | $394.92 | $540.99 | $540.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.03 / $1,095.26 / $1,403.47
| Facility | | $378.03 | $1,095.26 | $1,403.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.57 / $776.96 / $2,607.57
| Professional | | $621.57 | $776.96 | $2,607.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $703.29 / $1,217.23
| Facility | | $319.00 | $703.29 | $1,217.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.40 / $319.18 / $1,011.65
| Professional | | $216.40 | $319.18 | $1,011.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.82 / $513.94 / $607.59
| Professional | | $338.82 | $513.94 | $607.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.46 / $1,142.83 / $1,403.47
| Facility | | $527.46 | $1,142.83 | $1,403.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.64 / $621.57 / $1,114.44
| Professional | | $351.64 | $621.57 | $1,114.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.22 / $297.54 / $794.57
| Professional | | $227.22 | $297.54 | $794.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.99 / $622.13 / $622.13
| Facility | | $540.99 | $622.13 | $622.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.82 / $513.94 / $650.23
| Professional | | $338.82 | $513.94 | $650.23 |