- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $380.19 / $741.31
| Professional | | $302.00 | $380.19 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $776.25 / $3,715.35
| Facility | | $741.31 | $776.25 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $602.56 / $812.83
| Professional | | $338.84 | $602.56 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,023.29 / $1,348.96
| Facility | | $891.25 | $1,023.29 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $707.95
| Professional | | $562.34 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $575.44
| Facility | | $436.52 | $436.52 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $478.63
| Professional | | $323.59 | $323.59 | $478.63 |
- 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
- $691.83 / $691.83 / $1,047.13
| Professional | | $691.83 | $691.83 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $776.25 / $3,715.35
| Facility | | $741.31 | $776.25 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $602.56 / $891.25
| Professional | | $338.84 | $602.56 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $724.44
| Professional | | $562.34 | $707.95 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.52 / $501.19 / $912.01
| Facility | | $0.52 | $501.19 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $691.83
| Professional | | $323.59 | $501.19 | $691.83 |