- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,047.13 / $1,047.13
| Facility | | $457.09 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $309.03 / $457.09
| Professional | | $263.03 | $309.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $1,122.02
| Professional | | $338.84 | $338.84 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,230.27 / $1,949.84
| Facility | | $1,047.13 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $575.44 / $1,174.90
| Professional | | $436.52 | $575.44 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,318.26 / $2,238.72
| Facility | | $229.09 | $1,318.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $1,819.70
| Facility | | $229.09 | $354.81 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $229.09 / $691.83
| Professional | | $190.55 | $229.09 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $85.11 / $575.44
| Professional | | $50.12 | $85.11 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $870.96 / $1,258.93
| Professional | | $489.78 | $870.96 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $1,819.70
| Facility | | $758.58 | $758.58 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,089.30 / $2,884.03
| Professional | | $1,096.48 | $2,089.30 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $457.09
| Facility | | $302.00 | $302.00 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $229.09 / $741.31
| Professional | | $158.49 | $229.09 | $741.31 |