- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.68 / $780.68 / $780.68
| Facility | | $780.68 | $780.68 | $780.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.76 / $780.68 / $1,006.06
| Professional | | $719.76 | $780.68 | $1,006.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $3,492.83 / $8,487.06
| Facility | | $1,100.00 | $3,492.83 | $8,487.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.59 / $1,155.00 / $1,744.87
| Professional | | $654.59 | $1,155.00 | $1,744.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,896.45 / $2,307.25 / $2,971.30
| Facility | | $1,896.45 | $2,307.25 | $2,971.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,169.97 / $1,377.44 / $1,377.44
| Professional | | $1,169.97 | $1,377.44 | $1,377.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.35 / $1,033.49 / $1,252.59
| Facility | | $837.35 | $1,033.49 | $1,252.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.27 / $837.35 / $1,553.63
| Professional | | $611.27 | $837.35 | $1,553.63 |
- 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
- $1,446.65 / $1,446.65 / $1,518.98
| Professional | | $1,446.65 | $1,446.65 | $1,518.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.63 / $1,062.63 / $1,062.63
| Professional | | $1,062.63 | $1,062.63 | $1,062.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,492.83 / $8,487.06 / $8,487.06
| Facility | | $3,492.83 | $8,487.06 | $8,487.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.26 / $891.39 / $1,744.87
| Professional | | $594.26 | $891.39 | $1,744.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.07 / $557.12 / $742.21
| Facility | | $1.07 | $557.12 | $742.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.26 / $891.39 / $1,446.65
| Professional | | $594.26 | $891.39 | $1,446.65 |