- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.94 / $578.94 / $578.94
| Facility | | $578.94 | $578.94 | $578.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.78 / $578.94 / $746.09
| Professional | | $510.78 | $578.94 | $746.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,097.11 / $6,293.94
| Facility | | $818.35 | $2,097.11 | $6,293.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.44 / $824.88 / $1,293.99
| Professional | | $485.44 | $824.88 | $1,293.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.39 / $1,711.04 / $2,203.48
| Facility | | $1,406.39 | $1,711.04 | $2,203.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.42 / $1,021.49 / $1,021.49
| Professional | | $954.42 | $1,021.49 | $1,021.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.97 / $766.44 / $928.93
| Facility | | $620.97 | $766.44 | $928.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.31 / $620.97 / $1,152.00
| Professional | | $453.31 | $620.97 | $1,152.00 |
- 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
- $1,072.82 / $1,072.82 / $1,126.46
| Professional | | $1,072.82 | $1,072.82 | $1,126.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.82 / $651.82 / $651.82
| Professional | | $651.82 | $651.82 | $651.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.11 / $6,293.94 / $6,293.94
| Facility | | $2,097.11 | $6,293.94 | $6,293.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.70 / $661.04 / $1,293.99
| Professional | | $440.70 | $661.04 | $1,293.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.70 / $661.04 / $1,293.99
| Professional | | $440.70 | $661.04 | $1,293.99 |