- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Facility | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $676.08 / $1,148.15
| Professional | | $575.44 | $676.08 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,311.31 / $7,079.46
| Facility | | $1,479.11 | $3,311.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,548.82 / $2,290.87
| Professional | | $1,000.00 | $1,548.82 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,290.87 / $5,495.41
| Facility | | $1,445.44 | $2,290.87 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,737.80 / $2,691.53
| Professional | | $1,000.00 | $1,737.80 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,187.76 / $4,265.80
| Facility | | $1,778.28 | $2,187.76 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $2,454.71
| Professional | | $1,096.48 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $954.99 / $1,905.46
| Facility | | $602.56 | $954.99 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,174.90 / $6,456.54
| Professional | | $616.60 | $1,174.90 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,311.31 / $8,511.38
| Facility | | $794.33 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,096.48 / $2,089.30
| Professional | | $616.60 | $1,096.48 | $2,089.30 |