- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.48 / $733.48 / $733.48
| Facility | | $733.48 | $733.48 | $733.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.84 / $733.48 / $952.53
| Professional | | $585.84 | $733.48 | $952.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.53 / $794.42 / $1,231.14
| Professional | | $765.53 | $794.42 | $1,231.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.11 / $876.11 / $876.11
| Facility | | $876.11 | $876.11 | $876.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.00 / $828.32 / $1,438.52
| Professional | | $652.00 | $828.32 | $1,438.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,666.01 / $1,666.01 / $1,666.01
| Facility | | $1,666.01 | $1,666.01 | $1,666.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.17 / $1,044.96 / $1,563.83
| Professional | | $762.17 | $1,044.96 | $1,563.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.55 / $912.55 / $912.55
| Professional | | $912.55 | $912.55 | $912.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.79 / $756.78 / $2,004.56
| Professional | | $604.79 | $756.78 | $2,004.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.70 / $479.70 / $479.70
| Facility | | $479.70 | $479.70 | $479.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.70 / $1,099.80 / $1,551.70
| Professional | | $479.70 | $1,099.80 | $1,551.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.11 / $876.11 / $876.11
| Facility | | $876.11 | $876.11 | $876.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.00 / $830.53 / $1,438.52
| Professional | | $652.00 | $830.53 | $1,438.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $751.61 / $751.61 / $751.61
| Facility | | $751.61 | $751.61 | $751.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.71 / $751.61 / $781.12
| Professional | | $626.71 | $751.61 | $781.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.76 / $692.77 / $1,136.58
| Professional | | $550.76 | $692.77 | $1,136.58 |