- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $2,290.87
| Professional | | $575.44 | $724.44 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,698.24 / $8,317.64
| Facility | | $1,513.56 | $1,698.24 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,202.26 / $1,698.24
| Professional | | $645.65 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,187.76 / $2,884.03
| Facility | | $1,819.70 | $2,187.76 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,288.25 / $1,288.25
| Professional | | $1,202.26 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $977.24 / $1,174.90
| Facility | | $831.76 | $977.24 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $891.25
| Professional | | $602.56 | $602.56 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $2,238.72
| Professional | | $1,479.11 | $1,479.11 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,698.24 / $8,317.64
| Facility | | $1,513.56 | $1,698.24 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,258.93 / $1,698.24
| Professional | | $645.65 | $1,258.93 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.05 / $851.14 / $1,778.28
| Facility | | $1.05 | $851.14 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $1,479.11
| Professional | | $616.60 | $891.25 | $1,479.11 |