- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.94 / $444.52 / $2,425.12
| Facility | | $350.94 | $444.52 | $2,425.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $432.83 / $754.19
| Professional | | $350.94 | $432.83 | $754.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $310.00 / $409.43
| Professional | | $5.00 | $310.00 | $409.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.90 / $584.90 / $584.90
| Facility | | $584.90 | $584.90 | $584.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.71 / $1,220.82 / $2,718.23
| Facility | | $408.71 | $1,220.82 | $2,718.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.95 / $429.86 / $1,134.19
| Professional | | $311.95 | $429.86 | $1,134.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,828.48 / $2,828.48 / $2,828.48
| Facility | | $2,828.48 | $2,828.48 | $2,828.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,924.50 / $2,924.50 / $4,386.75
| Professional | | $2,924.50 | $2,924.50 | $4,386.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.68 / $584.90 / $1,023.58
| Facility | | $438.68 | $584.90 | $1,023.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.66 / $584.90 / $731.13
| Professional | | $552.66 | $584.90 | $731.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $701.88 / $1,316.03
| Professional | | $380.19 | $701.88 | $1,316.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.52 / $584.90 / $2,057.92
| Facility | | $444.52 | $584.90 | $2,057.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.49 / $526.41 / $986.37
| Professional | | $331.49 | $526.41 | $986.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.66 / $336.98 / $481.40
| Professional | | $245.66 | $336.98 | $481.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.11 / $288.83 / $584.90
| Professional | | $228.11 | $288.83 | $584.90 |