- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,388.44 / $5,623.41
| Facility | | $724.44 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $776.25 / $2,137.96
| Professional | | $645.65 | $776.25 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $5,623.41
| Facility | | $56.23 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,047.13 / $5,623.41
| Professional | | $562.34 | $1,047.13 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,318.26 / $2,511.89
| Professional | | $776.25 | $1,318.26 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,071.52 / $8,511.38
| Facility | | $302.00 | $1,071.52 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $741.31 / $1,096.48
| Professional | | $380.19 | $741.31 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,148.15 / $1,698.24
| Professional | | $660.69 | $1,148.15 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $5,623.41
| Facility | | $56.23 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,047.13 / $5,623.41
| Professional | | $562.34 | $1,047.13 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $4,677.35
| Facility | | $954.99 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,096.48 / $1,995.26
| Professional | | $776.25 | $1,096.48 | $1,995.26 |