- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.13 / $350.88 / $357.63
| Facility | | $344.13 | $350.88 | $357.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.89 / $357.63 / $580.29
| Professional | | $323.89 | $357.63 | $580.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.74 / $366.74 / $458.84
| Professional | | $366.74 | $366.74 | $458.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.60 / $770.60 / $770.60
| Facility | | $770.60 | $770.60 | $770.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $454.00 / $454.00
| Facility | | $454.00 | $454.00 | $454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.42 / $331.42 / $454.00
| Professional | | $331.42 | $331.42 | $454.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,888.75 / $4,562.52 / $4,562.52
| Facility | | $3,888.75 | $4,562.52 | $4,562.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,610.54 / $4,610.54 / $5,449.13
| Professional | | $4,610.54 | $4,610.54 | $5,449.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.00 / $537.04 / $770.60
| Facility | | $234.00 | $537.04 | $770.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.00 / $708.95 / $855.88
| Professional | | $234.00 | $708.95 | $855.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.60 / $825.31 / $1,768.52
| Professional | | $770.60 | $825.31 | $1,768.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.00 / $514.90 / $770.60
| Facility | | $234.00 | $514.90 | $770.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.42 / $331.42 / $483.99
| Professional | | $331.42 | $331.42 | $483.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.06 / $436.81 / $520.01
| Professional | | $302.06 | $436.81 | $520.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.28 / $452.73 / $770.60
| Professional | | $435.28 | $452.73 | $770.60 |