- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.89 / $592.89 / $592.89
| Facility | | $592.89 | $592.89 | $592.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.89 / $592.89 / $764.05
| Professional | | $592.89 | $592.89 | $764.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.00 / $2,649.33 / $7,228.12
| Facility | | $925.00 | $2,649.33 | $7,228.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.05 / $926.29 / $1,325.15
| Professional | | $530.05 | $926.29 | $1,325.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.27 / $1,752.25 / $2,256.57
| Facility | | $1,440.27 | $1,752.25 | $2,256.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.39 / $1,046.10 / $1,046.10
| Professional | | $977.39 | $1,046.10 | $1,046.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.15 / $784.88 / $951.29
| Facility | | $713.15 | $784.88 | $951.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.60 / $713.14 / $1,513.13
| Professional | | $520.60 | $713.14 | $1,513.13 |
- 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
- $1,098.67 / $1,098.67 / $1,153.59
| Professional | | $1,098.67 | $1,098.67 | $1,153.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $725.09 / $725.09 / $725.09
| Professional | | $725.09 | $725.09 | $725.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,649.33 / $7,228.12 / $7,228.12
| Facility | | $2,649.33 | $7,228.12 | $7,228.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.48 / $676.97 / $1,325.15
| Professional | | $474.48 | $676.97 | $1,325.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.29 / $877.39 / $1,153.59
| Professional | | $564.29 | $877.39 | $1,153.59 |