- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $453.90
| Facility | | $449.41 | $449.41 | $453.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $494.35
| Professional | | $449.41 | $449.41 | $494.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.82 / $561.23 / $949.55
| Facility | | $466.82 | $561.23 | $949.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $511.02 / $1,606.07
| Professional | | $449.41 | $511.02 | $1,606.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $359.53
| Professional | | $100.00 | $100.00 | $359.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.97 / $423.97 / $449.41
| Facility | | $423.97 | $423.97 | $449.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $551.16
| Professional | | $449.41 | $449.41 | $551.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.60 / $674.96 / $828.36
| Professional | | $613.60 | $674.96 | $828.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.47 / $561.76 / $979.71
| Professional | | $404.47 | $561.76 | $979.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $2,709.11 / $2,870.93
| Facility | | $1,380.00 | $2,709.11 | $2,870.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,709.11 / $2,709.11 / $2,709.11
| Professional | | $2,709.11 | $2,709.11 | $2,709.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.41 / $494.35 / $786.47
| Facility | | $449.41 | $494.35 | $786.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $1,173.00
| Professional | | $449.41 | $449.41 | $1,173.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.53 / $613.60 / $736.32
| Professional | | $359.53 | $613.60 | $736.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $1,348.77
| Professional | | $449.41 | $449.41 | $1,348.77 |