- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.36 / $9,606.08 / $12,802.55
| Facility | | $627.36 | $9,606.08 | $12,802.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.46 / $627.36 / $738.07
| Professional | | $590.46 | $627.36 | $738.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.91 / $1,374.42 / $2,162.66
| Facility | | $591.91 | $1,374.42 | $2,162.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.91 / $615.05 / $1,497.53
| Professional | | $591.91 | $615.05 | $1,497.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $809.31 / $1,288.83 / $2,565.44
| Facility | | $809.31 | $1,288.83 | $2,565.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.36 / $627.36 / $1,137.97
| Facility | | $627.36 | $627.36 | $1,137.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.36 / $627.36 / $627.36
| Professional | | $627.36 | $627.36 | $627.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.44 / $499.49 / $8,090.00
| Facility | | $332.44 | $499.49 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.36 / $627.36 / $627.36
| Professional | | $627.36 | $627.36 | $627.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,758.91 / $11,758.91 / $11,758.91
| Facility | | $11,758.91 | $11,758.91 | $11,758.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.17 / $2,460.48 / $2,460.48
| Facility | | $701.17 | $2,460.48 | $2,460.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.05 / $615.05 / $2,804.67
| Professional | | $615.05 | $615.05 | $2,804.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.05 / $615.05 / $1,017.33
| Professional | | $615.05 | $615.05 | $1,017.33 |