- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.03 / $511.03 / $511.03
| Facility | | $511.03 | $511.03 | $511.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.03 / $568.47 / $749.08
| Professional | | $511.03 | $568.47 | $749.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.46 / $3,331.77 / $5,580.24
| Facility | | $1,046.46 | $3,331.77 | $5,580.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.93 / $868.85 / $1,142.19
| Professional | | $484.93 | $868.85 | $1,142.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.07 / $1,510.32 / $1,945.01
| Facility | | $1,277.07 | $1,510.32 | $1,945.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.88 / $765.88 / $843.66
| Professional | | $765.88 | $765.88 | $843.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.69 / $736.69 / $958.87
| Facility | | $736.69 | $736.69 | $958.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.78 / $537.78 / $1,389.38
| Professional | | $537.78 | $537.78 | $1,389.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.98 / $946.98 / $994.33
| Professional | | $946.98 | $946.98 | $994.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.30 / $778.30 / $778.30
| Facility | | $778.30 | $778.30 | $778.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.89 / $799.89 / $799.89
| Professional | | $799.89 | $799.89 | $799.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,432.63 / $5,580.24 / $5,580.24
| Facility | | $2,432.63 | $5,580.24 | $5,580.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.05 / $583.50 / $1,142.19
| Professional | | $445.05 | $583.50 | $1,142.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.64 / $583.50 / $1,142.19
| Professional | | $452.64 | $583.50 | $1,142.19 |