- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.68 / $677.68 / $677.68
| Facility | | $677.68 | $677.68 | $677.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.68 / $733.60 / $993.37
| Professional | | $677.68 | $733.60 | $993.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.69 / $4,418.22 / $7,399.97
| Facility | | $1,387.69 | $4,418.22 | $7,399.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.05 / $1,152.18 / $1,514.65
| Professional | | $643.05 | $1,152.18 | $1,514.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,693.52 / $2,002.83 / $2,579.27
| Facility | | $1,693.52 | $2,002.83 | $2,579.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.18 / $1,422.08 / $1,422.08
| Professional | | $1,117.18 | $1,422.08 | $1,422.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.23 / $1,115.23 / $1,115.23
| Facility | | $1,115.23 | $1,115.23 | $1,115.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.12 / $1,115.23 / $1,842.38
| Professional | | $814.12 | $1,115.23 | $1,842.38 |
- 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
- $1,255.78 / $1,255.78 / $1,318.57
| Professional | | $1,255.78 | $1,255.78 | $1,318.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.32 / $1,132.32 / $1,132.32
| Professional | | $1,132.32 | $1,132.32 | $1,132.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,225.93 / $7,399.97 / $7,399.97
| Facility | | $3,225.93 | $7,399.97 | $7,399.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.19 / $773.78 / $1,514.65
| Professional | | $590.19 | $773.78 | $1,514.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.86 / $829.08 / $1,514.65
| Professional | | $605.86 | $829.08 | $1,514.65 |