- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.79 / $566.79 / $566.79
| Facility | | $566.79 | $566.79 | $566.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.79 / $566.79 / $730.43
| Professional | | $566.79 | $566.79 | $730.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.38 / $2,377.08 / $7,237.01
| Facility | | $753.38 | $2,377.08 | $7,237.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.62 / $904.13 / $1,266.82
| Professional | | $517.62 | $904.13 | $1,266.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.87 / $1,675.12 / $2,157.23
| Facility | | $1,376.87 | $1,675.12 | $2,157.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.44 / $1,000.06 / $1,000.06
| Professional | | $849.44 | $1,000.06 | $1,000.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.02 / $750.35 / $909.44
| Facility | | $714.02 | $750.35 | $909.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.23 / $714.01 / $1,562.63
| Professional | | $521.23 | $714.01 | $1,562.63 |
- 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
- $1,050.31 / $1,050.31 / $1,102.83
| Professional | | $1,050.31 | $1,050.31 | $1,102.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $725.98 / $725.98 / $725.98
| Professional | | $725.98 | $725.98 | $725.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,278.68 / $7,237.01 / $7,237.01
| Facility | | $3,278.68 | $7,237.01 | $7,237.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.06 / $647.16 / $1,266.82
| Professional | | $475.06 | $647.16 | $1,266.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.16 / $647.16 / $1,266.82
| Professional | | $483.16 | $647.16 | $1,266.82 |