- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.29 / $512.29 / $512.29
| Facility | | $512.29 | $512.29 | $512.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.96 / $512.29 / $782.98
| Professional | | $455.96 | $512.29 | $782.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.10 / $1,895.61 / $4,826.53
| Facility | | $694.10 | $1,895.61 | $4,826.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.62 / $757.90 / $1,145.01
| Professional | | $484.62 | $757.90 | $1,145.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.47 / $1,514.04 / $1,949.79
| Facility | | $1,244.47 | $1,514.04 | $1,949.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $844.51 / $985.57 / $985.57
| Professional | | $844.51 | $985.57 | $985.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.49 / $678.18 / $821.98
| Facility | | $583.49 | $678.18 | $821.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.95 / $583.49 / $1,082.63
| Professional | | $425.95 | $583.49 | $1,082.63 |
- 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
- $949.31 / $949.31 / $996.78
| Professional | | $949.31 | $949.31 | $996.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.37 / $665.37 / $665.37
| Professional | | $665.37 | $665.37 | $665.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.61 / $4,826.53 / $4,826.53
| Facility | | $1,895.61 | $4,826.53 | $4,826.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.00 / $626.73 / $1,145.01
| Professional | | $458.00 | $626.73 | $1,145.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.72 / $466.72 / $466.72
| Facility | | $466.72 | $466.72 | $466.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.00 / $626.73 / $1,060.28
| Professional | | $458.00 | $626.73 | $1,060.28 |