- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,348.96 / $1,819.70
| Professional | | $870.96 | $1,348.96 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Professional | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,230.27 / $1,288.25
| Professional | | $1,000.00 | $1,230.27 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,344.23
| Facility | | $2,290.87 | $2,290.87 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $1,071.52 / $1,071.52
| Facility | | $169.82 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $1,071.52 / $1,318.26
| Professional | | $169.82 | $1,071.52 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $10,715.19 / $10,715.19
| Facility | | $2,137.96 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $630.96 / $1,737.80
| Facility | | $234.42 | $630.96 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,819.70 / $1,819.70
| Professional | | $1,071.52 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $213.80 / $2,137.96
| Professional | | $144.54 | $213.80 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,071.52 / $1,737.80
| Facility | | $234.42 | $1,071.52 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $912.01 / $1,288.25
| Professional | | $630.96 | $912.01 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $660.69 / $1,288.25
| Facility | | $81.28 | $660.69 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $954.99 / $1,412.54
| Professional | | $758.58 | $954.99 | $1,412.54 |