- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.51 / $425.51 / $425.51
| Facility | | $425.51 | $425.51 | $425.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.91 / $425.51 / $607.32
| Professional | | $383.91 | $425.51 | $607.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $1,596.07 / $4,288.35
| Facility | | $818.35 | $1,596.07 | $4,288.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.42 / $739.09 / $951.05
| Professional | | $380.42 | $739.09 | $951.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.29 / $563.29 / $1,672.97
| Facility | | $563.29 | $563.29 | $1,672.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.47 / $864.09 / $864.09
| Professional | | $701.47 | $864.09 | $864.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.40 / $563.29 / $682.73
| Facility | | $456.40 | $563.29 | $682.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.17 / $456.40 / $911.63
| Professional | | $333.17 | $456.40 | $911.63 |
- 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
- $788.49 / $788.49 / $827.91
| Professional | | $788.49 | $788.49 | $827.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.86 / $559.86 / $559.86
| Professional | | $559.86 | $559.86 | $559.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,596.07 / $4,288.35 / $4,288.35
| Facility | | $1,596.07 | $4,288.35 | $4,288.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.39 / $520.57 / $951.05
| Professional | | $364.39 | $520.57 | $951.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.00 / $360.00 / $360.00
| Facility | | $360.00 | $360.00 | $360.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.78 / $520.57 / $865.67
| Professional | | $370.78 | $520.57 | $865.67 |