- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.62 / $1,445.99 / $1,608.74
| Facility | | $322.62 | $1,445.99 | $1,608.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.62 / $322.62 / $812.92
| Professional | | $322.62 | $322.62 | $812.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.95 / $1,195.89 / $1,821.68
| Facility | | $616.95 | $1,195.89 | $1,821.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.72 / $527.87 / $2,093.34
| Professional | | $316.72 | $527.87 | $2,093.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.20 / $1,200.06 / $2,098.00
| Facility | | $839.20 | $1,200.06 | $2,098.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.79 / $137.79 / $522.59
| Professional | | $137.79 | $137.79 | $522.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.80 / $491.92 / $1,200.92
| Facility | | $274.80 | $491.92 | $1,200.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.77 / $525.20 / $1,375.78
| Professional | | $316.77 | $525.20 | $1,375.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.74 / $761.74 / $896.16
| Professional | | $761.74 | $761.74 | $896.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.87 / $527.87 / $1,634.76
| Professional | | $527.87 | $527.87 | $1,634.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.49 / $2,507.38 / $2,507.38
| Facility | | $918.49 | $2,507.38 | $2,507.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.72 / $316.72 / $2,639.35
| Professional | | $316.72 | $316.72 | $2,639.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.72 / $316.72 / $316.72
| Facility | | $316.72 | $316.72 | $316.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.72 / $316.72 / $923.77
| Professional | | $316.72 | $316.72 | $923.77 |