- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.40 / $462.40 / $462.40
| Facility | | $462.40 | $462.40 | $462.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.96 / $479.02 / $917.00
| Professional | | $425.96 | $479.02 | $917.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.41 / $1,685.56 / $3,153.85
| Facility | | $534.41 | $1,685.56 | $3,153.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.75 / $672.24 / $814.59
| Professional | | $384.75 | $672.24 | $814.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.00 / $1,362.55 / $1,754.71
| Facility | | $1,133.00 | $1,362.55 | $1,754.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.63 / $1,044.42 / $1,323.57
| Professional | | $682.63 | $1,044.42 | $1,323.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.97 / $636.97 / $712.60
| Facility | | $636.97 | $636.97 | $712.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.99 / $636.97 / $748.13
| Professional | | $464.99 | $636.97 | $748.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.45 / $860.45 / $903.47
| Professional | | $860.45 | $860.45 | $903.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.15 / $732.15 / $732.15
| Facility | | $732.15 | $732.15 | $732.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.56 / $732.15 / $732.15
| Professional | | $505.56 | $732.15 | $732.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.63 / $3,153.85 / $3,153.85
| Facility | | $1,329.63 | $3,153.85 | $3,153.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.75 / $526.41 / $840.73
| Professional | | $384.75 | $526.41 | $840.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.75 / $533.52 / $860.45
| Professional | | $384.75 | $533.52 | $860.45 |