- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.08 / $1,281.29 / $1,957.30
| Facility | | $379.08 | $1,281.29 | $1,957.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.80 / $379.08 / $3,009.24
| Professional | | $280.80 | $379.08 | $3,009.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,616.43 / $2,153.96 / $8,459.92
| Facility | | $1,616.43 | $2,153.96 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.04 / $365.04 / $365.04
| Professional | | $365.04 | $365.04 | $365.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.13 / $691.23 / $1,552.76
| Facility | | $444.13 | $691.23 | $1,552.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.38 / $431.48 / $812.13
| Professional | | $215.38 | $431.48 | $812.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.45 / $631.79 / $889.20
| Professional | | $278.45 | $631.79 | $889.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.43 / $900.43 / $900.43
| Facility | | $900.43 | $900.43 | $900.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.80 / $1,281.29 / $1,932.84
| Facility | | $397.80 | $1,281.29 | $1,932.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.24 / $397.80 / $1,932.84
| Professional | | $318.24 | $397.80 | $1,932.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.64 / $702.00 / $4,189.60
| Professional | | $692.64 | $702.00 | $4,189.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.58 / $778.60 / $1,552.76
| Facility | | $455.58 | $778.60 | $1,552.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.38 / $433.37 / $815.23
| Professional | | $215.38 | $433.37 | $815.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.00 / $468.00 / $514.79
| Facility | | $468.00 | $468.00 | $514.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.00 / $468.00 / $514.79
| Professional | | $468.00 | $468.00 | $514.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.56 / $280.80 / $655.20
| Professional | | $196.56 | $280.80 | $655.20 |