- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Facility | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $407.38 / $741.31
| Professional | | $302.00 | $407.38 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $954.99 / $3,801.89
| Facility | | $831.76 | $954.99 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $616.60 / $954.99
| Professional | | $363.08 | $616.60 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $1,621.81
| Facility | | $537.03 | $537.03 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $831.76
| Professional | | $602.56 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $537.03 / $645.65
| Facility | | $457.09 | $537.03 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $467.74
| Professional | | $331.13 | $331.13 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $1,230.27
| Professional | | $812.83 | $812.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Professional | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $954.99 / $3,801.89
| Facility | | $831.76 | $954.99 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $676.08 / $1,047.13
| Professional | | $363.08 | $676.08 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.56 / $537.03 / $954.99
| Facility | | $0.56 | $537.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $537.03 / $812.83
| Professional | | $354.81 | $537.03 | $812.83 |