- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.51 / $458.51 / $458.51
| Facility | | $458.51 | $458.51 | $458.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.51 / $505.39 / $672.12
| Professional | | $458.51 | $505.39 | $672.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.04 / $2,713.48 / $5,006.71
| Facility | | $819.04 | $2,713.48 | $5,006.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.08 / $779.54 / $1,024.80
| Professional | | $435.08 | $779.54 | $1,024.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.82 / $1,355.09 / $1,745.11
| Facility | | $1,145.82 | $1,355.09 | $1,745.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.16 / $756.96 / $756.96
| Professional | | $687.16 | $756.96 | $756.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.38 / $731.38 / $860.28
| Facility | | $731.38 | $731.38 | $860.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.91 / $731.38 / $1,246.50
| Professional | | $533.91 | $731.38 | $1,246.50 |
- 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
- $849.64 / $849.64 / $892.12
| Professional | | $849.64 | $849.64 | $892.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.84 / $608.84 / $691.19
| Facility | | $608.84 | $608.84 | $691.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.84 / $608.84 / $691.19
| Professional | | $608.84 | $608.84 | $691.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,182.53 / $5,006.71 / $5,006.71
| Facility | | $2,182.53 | $5,006.71 | $5,006.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.31 / $523.53 / $1,024.80
| Professional | | $399.31 | $523.53 | $1,024.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.11 / $560.94 / $1,024.80
| Professional | | $406.11 | $560.94 | $1,024.80 |