- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.39 / $686.39 / $686.39
| Facility | | $686.39 | $686.39 | $686.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.58 / $686.39 / $901.28
| Professional | | $605.58 | $686.39 | $901.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.00 / $2,915.44 / $7,462.01
| Facility | | $880.00 | $2,915.44 | $7,462.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.53 / $944.70 / $1,534.13
| Professional | | $575.53 | $944.70 | $1,534.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,667.39 / $2,028.58 / $2,612.42
| Facility | | $1,667.39 | $2,028.58 | $2,612.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.55 / $1,131.55 / $1,211.06
| Professional | | $1,131.55 | $1,131.55 | $1,211.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.22 / $908.66 / $1,101.32
| Facility | | $736.22 | $908.66 | $1,101.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.44 / $736.22 / $1,365.75
| Professional | | $537.44 | $736.22 | $1,365.75 |
- 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
- $1,271.92 / $1,271.92 / $1,335.52
| Professional | | $1,271.92 | $1,271.92 | $1,335.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.53 / $749.53 / $749.53
| Professional | | $749.53 | $749.53 | $749.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,152.76 / $7,462.01 / $7,462.01
| Facility | | $3,152.76 | $7,462.01 | $7,462.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.48 / $783.73 / $1,534.13
| Professional | | $522.48 | $783.73 | $1,534.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.26 / $783.73 / $1,453.52
| Professional | | $531.26 | $783.73 | $1,453.52 |