- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,318.26 / $2,089.30
| Facility | | $588.84 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $676.08
| Professional | | $416.87 | $549.54 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $933.25
| Professional | | $338.84 | $338.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $691.83
| Facility | | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $691.83 / $691.83
| Professional | | $501.19 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,479.11 / $1,778.28
| Facility | | $446.68 | $1,479.11 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $3,311.31 / $3,311.31
| Professional | | $691.83 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,148.15 / $2,630.27
| Facility | | $691.83 | $1,148.15 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $933.25 / $1,348.96
| Professional | | $724.44 | $933.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $676.08 / $1,230.27
| Professional | | $575.44 | $676.08 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $50,118.72
| Facility | | $891.25 | $1,288.25 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $707.95
| Professional | | $691.83 | $691.83 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $691.83 / $831.76
| Facility | | $616.60 | $691.83 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $416.87 / $912.01
| Professional | | $288.40 | $416.87 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $691.83 / $794.33
| Facility | | $416.87 | $691.83 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $691.83 / $1,380.38
| Professional | | $575.44 | $691.83 | $1,380.38 |