- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.89 / $677.89 / $677.89
| Facility | | $677.89 | $677.89 | $677.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.89 / $677.89 / $873.60
| Professional | | $677.89 | $677.89 | $873.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.20 / $2,811.85 / $7,050.38
| Facility | | $864.20 | $2,811.85 | $7,050.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.99 / $952.42 / $1,515.14
| Professional | | $587.99 | $952.42 | $1,515.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,646.76 / $2,003.47 / $2,580.09
| Facility | | $1,646.76 | $2,003.47 | $2,580.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.95 / $1,196.08 / $1,196.08
| Professional | | $1,015.95 | $1,196.08 | $1,196.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.15 / $897.44 / $1,087.70
| Facility | | $752.15 | $897.44 | $1,087.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.07 / $549.07 / $1,605.75
| Professional | | $549.07 | $549.07 | $1,605.75 |
- 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
- $1,256.19 / $1,256.19 / $1,319.00
| Professional | | $1,256.19 | $1,256.19 | $1,319.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.76 / $764.76 / $764.76
| Professional | | $764.76 | $764.76 | $764.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,811.85 / $7,050.38 / $7,050.38
| Facility | | $2,811.85 | $7,050.38 | $7,050.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.02 / $774.03 / $1,515.14
| Professional | | $516.02 | $774.03 | $1,515.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.27 / $774.03 / $1,460.86
| Professional | | $545.27 | $774.03 | $1,460.86 |