- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.43 / $503.01 / $1,244.41
| Facility | | $409.43 | $503.01 | $1,244.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.74 / $368.49 / $505.47
| Professional | | $7.74 | $368.49 | $505.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.93 / $584.90 / $584.90
| Professional | | $389.93 | $584.90 | $584.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.02 / $2,356.82 / $2,356.82
| Facility | | $1,316.02 | $2,356.82 | $2,356.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.41 / $711.83 / $1,725.01
| Professional | | $526.41 | $711.83 | $1,725.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.71 / $685.72 / $1,535.50
| Facility | | $398.71 | $685.72 | $1,535.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.26 / $407.62 / $1,010.44
| Professional | | $275.26 | $407.62 | $1,010.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.49 / $552.41 / $802.33
| Facility | | $368.49 | $552.41 | $802.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.37 / $802.33 / $1,500.00
| Professional | | $469.37 | $802.33 | $1,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $584.90 / $1,120.08
| Professional | | $380.19 | $584.90 | $1,120.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.45 / $401.17 / $802.33
| Professional | | $292.45 | $401.17 | $802.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.01 / $3,500.00 / $3,500.00
| Facility | | $1,433.01 | $3,500.00 | $3,500.00 |
- 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 |