- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.30 / $335.30 / $362.12
| Facility | | $335.30 | $335.30 | $362.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.30 / $362.12 / $670.59
| Professional | | $335.30 | $362.12 | $670.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.47 / $364.47 / $456.00
| Professional | | $364.47 | $364.47 | $456.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $765.83 / $765.83 / $765.83
| Facility | | $765.83 | $765.83 | $765.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.57 / $485.57 / $485.57
| Facility | | $485.57 | $485.57 | $485.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.47 / $354.47 / $485.57
| Professional | | $354.47 | $354.47 | $485.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,589.42 / $3,853.16 / $4,753.89
| Facility | | $1,589.42 | $3,853.16 | $4,753.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,024.43 / $5,145.03 / $5,868.53
| Professional | | $5,024.43 | $5,145.03 | $5,868.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.75 / $545.59 / $765.83
| Facility | | $241.75 | $545.59 | $765.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.48 / $689.25 / $765.83
| Professional | | $244.48 | $689.25 | $765.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.75 / $511.72 / $765.83
| Facility | | $241.75 | $511.72 | $765.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.47 / $354.47 / $517.64
| Professional | | $354.47 | $354.47 | $517.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.06 / $461.64 / $564.09
| Professional | | $312.06 | $461.64 | $564.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.21 / $456.56 / $765.83
| Professional | | $454.21 | $456.56 | $765.83 |