- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.01 / $467.01 / $467.01
| Facility | | $467.01 | $467.01 | $467.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.91 / $467.01 / $601.92
| Professional | | $447.91 | $467.01 | $601.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.42 / $1,692.88 / $4,222.76
| Facility | | $544.42 | $1,692.88 | $4,222.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.59 / $642.76 / $1,043.81
| Professional | | $391.59 | $642.76 | $1,043.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,134.48 / $1,380.23 / $1,777.47
| Facility | | $1,134.48 | $1,380.23 | $1,777.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.89 / $769.89 / $977.81
| Professional | | $769.89 | $769.89 | $977.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.74 / $618.24 / $749.32
| Facility | | $544.74 | $618.24 | $749.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.66 / $544.74 / $966.75
| Professional | | $397.66 | $544.74 | $966.75 |
- 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
- $865.41 / $865.41 / $908.68
| Professional | | $865.41 | $865.41 | $908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.85 / $694.85 / $694.85
| Facility | | $694.85 | $694.85 | $694.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.64 / $694.85 / $694.85
| Professional | | $623.64 | $694.85 | $694.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,692.88 / $4,222.76 / $4,222.76
| Facility | | $1,692.88 | $4,222.76 | $4,222.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.50 / $533.24 / $1,043.81
| Professional | | $355.50 | $533.24 | $1,043.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.32 / $956.32 / $956.32
| Professional | | $956.32 | $956.32 | $956.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.50 / $533.24 / $1,043.81
| Professional | | $355.50 | $533.24 | $1,043.81 |