- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.45 / $352.90 / $2,138.80
| Facility | | $176.45 | $352.90 | $2,138.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.45 / $178.21 / $1,314.08
| Professional | | $176.45 | $178.21 | $1,314.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.47 / $542.03 / $1,413.42
| Facility | | $166.47 | $542.03 | $1,413.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.45 / $185.27 / $2,475.46
| Professional | | $176.45 | $185.27 | $2,475.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.15 / $216.68 / $421.01
| Facility | | $189.15 | $216.68 | $421.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.51 / $290.26 / $366.43
| Professional | | $198.51 | $290.26 | $366.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.45 / $176.45 / $204.67
| Facility | | $176.45 | $176.45 | $204.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.45 / $176.45 / $186.07
| Professional | | $176.45 | $176.45 | $186.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.41 / $245.56 / $8,090.00
| Facility | | $155.41 | $245.56 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.45 / $176.45 / $176.45
| Professional | | $176.45 | $176.45 | $176.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.45 / $176.45 / $204.22
| Professional | | $176.45 | $176.45 | $204.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.27 / $746.43 / $2,764.35
| Facility | | $291.27 | $746.43 | $2,764.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.24 / $1,173.35 / $1,478.20
| Professional | | $782.24 | $1,173.35 | $1,478.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.03 / $1,413.42 / $1,413.42
| Facility | | $542.03 | $1,413.42 | $1,413.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.45 / $187.04 / $2,475.46
| Professional | | $176.45 | $187.04 | $2,475.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.41 / $211.94 / $306.08
| Facility | | $184.41 | $211.94 | $306.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.45 / $176.45 / $416.42
| Professional | | $176.45 | $176.45 | $416.42 |