- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.94 / $1,024.74 / $2,849.37
| Facility | | $350.94 | $1,024.74 | $2,849.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.54 / $386.03 / $497.17
| Professional | | $327.54 | $386.03 | $497.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.90 / $584.90 / $584.90
| Professional | | $584.90 | $584.90 | $584.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,330.67 / $2,606.00
| Facility | | $380.19 | $1,330.67 | $2,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.27 / $712.27 / $853.38
| Professional | | $712.27 | $712.27 | $853.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.84 / $2,778.28 / $2,778.28
| Facility | | $935.84 | $2,778.28 | $2,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,912.80 / $2,912.80 / $4,386.75
| Professional | | $2,912.80 | $2,912.80 | $4,386.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.94 / $584.90 / $863.12
| Facility | | $350.94 | $584.90 | $863.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.90 / $584.90 / $731.13
| Professional | | $584.90 | $584.90 | $731.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.41 / $731.12 / $1,316.03
| Professional | | $526.41 | $731.12 | $1,316.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $585.48 / $1,766.76
| Facility | | $380.19 | $585.48 | $1,766.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.41 / $701.88 / $1,023.58
| Professional | | $526.41 | $701.88 | $1,023.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.66 / $245.66 / $584.90
| Professional | | $245.66 | $245.66 | $584.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.83 / $288.83 / $584.90
| Professional | | $288.83 | $288.83 | $584.90 |