- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.31 / $1,268.04 / $2,258.42
| Facility | | $268.31 | $1,268.04 | $2,258.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $750.32 / $1,043.00
| Professional | | $400.00 | $750.32 | $1,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.57 / $812.43 / $8,639.91
| Facility | | $690.57 | $812.43 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.10 / $777.10 / $777.10
| Professional | | $777.10 | $777.10 | $777.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.46 / $748.84 / $748.84
| Facility | | $706.46 | $748.84 | $748.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.84 / $748.84 / $748.84
| Professional | | $748.84 | $748.84 | $748.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.31 / $598.97 / $831.90
| Facility | | $157.31 | $598.97 | $831.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.85 / $1,268.04 / $2,258.42
| Facility | | $748.85 | $1,268.04 | $2,258.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.74 / $756.33 / $2,258.42
| Professional | | $681.74 | $756.33 | $2,258.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.46 / $748.84 / $748.84
| Facility | | $706.46 | $748.84 | $748.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.84 / $748.84 / $748.84
| Professional | | $748.84 | $748.84 | $748.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.71 / $637.71 / $739.98
| Facility | | $637.71 | $637.71 | $739.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.71 / $637.71 / $739.98
| Professional | | $637.71 | $637.71 | $739.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.84 / $748.84 / $748.84
| Facility | | $748.84 | $748.84 | $748.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.85 / $748.85 / $1,057.63
| Professional | | $748.85 | $748.85 | $1,057.63 |