- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.26 / $357.26 / $357.26
| Facility | | $357.26 | $357.26 | $357.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.75 / $357.26 / $527.35
| Professional | | $353.75 | $357.26 | $527.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.53 / $1,470.69 / $3,969.20
| Facility | | $480.53 | $1,470.69 | $3,969.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.42 / $508.66 / $798.49
| Professional | | $337.42 | $508.66 | $798.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.94 / $472.94 / $1,404.63
| Facility | | $472.94 | $472.94 | $1,404.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.40 / $725.50 / $725.50
| Professional | | $535.40 | $725.50 | $725.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.67 / $472.94 / $573.22
| Facility | | $468.67 | $472.94 | $573.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.13 / $468.67 / $840.00
| Professional | | $342.13 | $468.67 | $840.00 |
- 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
- $662.03 / $662.03 / $695.13
| Professional | | $662.03 | $662.03 | $695.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.57 / $398.57 / $398.57
| Professional | | $398.57 | $398.57 | $398.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.69 / $3,969.20 / $3,969.20
| Facility | | $1,470.69 | $3,969.20 | $3,969.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.66 / $437.06 / $798.49
| Professional | | $312.66 | $437.06 | $798.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.20 / $383.20 / $383.20
| Facility | | $383.20 | $383.20 | $383.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.66 / $437.06 / $682.08
| Professional | | $312.66 | $437.06 | $682.08 |