- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.05 / $459.05 / $459.05
| Facility | | $459.05 | $459.05 | $459.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.24 / $472.64 / $557.30
| Professional | | $389.24 | $472.64 | $557.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.98 / $707.21 / $2,027.34
| Professional | | $407.98 | $707.21 | $2,027.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.96 / $1,470.03 / $2,255.06
| Facility | | $1,257.96 | $1,470.03 | $2,255.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.99 / $1,130.56 / $1,409.47
| Professional | | $575.99 | $1,130.56 | $1,409.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.59 / $492.84 / $768.49
| Facility | | $418.59 | $492.84 | $768.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.13 / $503.23 / $796.22
| Facility | | $402.13 | $503.23 | $796.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.62 / $794.73 / $2,830.35
| Professional | | $417.62 | $794.73 | $2,830.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.40 / $70.00 / $1,700.66
| Professional | | $58.40 | $70.00 | $1,700.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.59 / $495.68 / $768.49
| Facility | | $418.59 | $495.68 | $768.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.16 / $1,085.99 / $1,523.17
| Professional | | $605.16 | $1,085.99 | $1,523.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,131.46 / $2,131.46 / $2,131.46
| Facility | | $2,131.46 | $2,131.46 | $2,131.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.01 / $1,998.81 / $2,830.35
| Professional | | $720.01 | $1,998.81 | $2,830.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.47 / $445.47 / $445.47
| Professional | | $445.47 | $445.47 | $445.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.47 / $2,321.37 / $2,321.37
| Professional | | $445.47 | $2,321.37 | $2,321.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.10 / $715.58 / $1,436.87
| Professional | | $415.10 | $715.58 | $1,436.87 |