- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.18 / $340.18 / $340.18
| Facility | | $340.18 | $340.18 | $340.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.18 / $340.25 / $639.35
| Professional | | $340.18 | $340.25 | $639.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.19 / $1,330.24 / $4,817.02
| Facility | | $428.19 | $1,330.24 | $4,817.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.44 / $584.71 / $760.30
| Professional | | $379.44 | $584.71 | $760.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.34 / $540.34 / $1,604.81
| Facility | | $540.34 | $540.34 | $1,604.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.79 / $654.42 / $654.42
| Professional | | $560.79 | $654.42 | $654.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.34 / $572.24 / $663.31
| Facility | | $450.34 | $572.24 | $663.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.22 / $663.31 / $1,085.63
| Professional | | $484.22 | $663.31 | $1,085.63 |
- 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
- $630.35 / $630.35 / $661.87
| Professional | | $630.35 | $630.35 | $661.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.25 / $454.25 / $454.25
| Facility | | $454.25 | $454.25 | $454.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.25 / $483.21 / $483.21
| Professional | | $454.25 | $483.21 | $483.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,900.79 / $4,817.02 / $4,817.02
| Facility | | $1,900.79 | $4,817.02 | $4,817.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.20 / $416.18 / $760.30
| Professional | | $316.20 | $416.18 | $760.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.44 / $584.71 / $692.05
| Professional | | $379.44 | $584.71 | $692.05 |