- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $758.58
| Professional | | $478.63 | $630.96 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $1,737.80 / $3,890.45
| Facility | | $91.20 | $1,737.80 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $645.65 / $1,122.02
| Professional | | $61.66 | $645.65 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $93.33 / $154.88
| Facility | | $77.62 | $93.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,380.38 / $1,380.38
| Professional | | $1,174.90 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $851.14
| Facility | | $575.44 | $575.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $575.44 / $870.96
| Professional | | $75.86 | $575.44 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $398.11 / $831.76
| Professional | | $46.77 | $398.11 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $67.61 / $67.61
| Facility | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $933.25
| Professional | | $891.25 | $891.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $1,737.80 / $3,890.45
| Facility | | $91.20 | $1,737.80 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $724.44 / $1,122.02
| Professional | | $64.57 | $724.44 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $109.65 / $645.65
| Facility | | $45.71 | $109.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $398.11 / $831.76
| Professional | | $48.98 | $398.11 | $831.76 |