- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.74 / $463.74 / $1,073.57
| Facility | | $463.74 | $463.74 | $1,073.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.74 / $511.16 / $679.77
| Professional | | $463.74 | $511.16 | $679.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.63 / $3,023.50 / $5,063.85
| Facility | | $949.63 | $3,023.50 | $5,063.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.05 / $788.44 / $1,036.51
| Professional | | $440.05 | $788.44 | $1,036.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,158.90 / $1,370.56 / $1,765.02
| Facility | | $1,158.90 | $1,370.56 | $1,765.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.84 / $818.23 / $818.23
| Professional | | $796.84 | $818.23 | $818.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.01 / $607.01 / $607.01
| Facility | | $607.01 | $607.01 | $607.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.12 / $607.00 / $1,118.67
| Professional | | $443.12 | $607.00 | $1,118.67 |
- 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
- $859.34 / $859.34 / $902.31
| Professional | | $859.34 | $859.34 | $902.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.83 / $774.83 / $774.83
| Professional | | $774.83 | $774.83 | $774.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,207.44 / $5,063.85 / $5,063.85
| Facility | | $2,207.44 | $5,063.85 | $5,063.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.41 / $529.51 / $1,036.51
| Professional | | $373.41 | $529.51 | $1,036.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.75 / $529.51 / $1,036.51
| Professional | | $410.75 | $529.51 | $1,036.51 |