- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.92 / $634.92 / $634.92
| Facility | | $634.92 | $634.92 | $634.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.92 / $687.33 / $930.73
| Professional | | $634.92 | $687.33 | $930.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.17 / $4,139.57 / $6,933.23
| Facility | | $1,300.17 | $4,139.57 | $6,933.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.50 / $1,079.50 / $1,419.12
| Professional | | $602.50 | $1,079.50 | $1,419.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.70 / $1,876.50 / $2,416.58
| Facility | | $1,586.70 | $1,876.50 | $2,416.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.72 / $1,120.27 / $1,120.27
| Professional | | $1,046.72 | $1,120.27 | $1,120.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.10 / $831.10 / $831.10
| Facility | | $831.10 | $831.10 | $831.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.70 / $831.10 / $1,726.13
| Professional | | $606.70 | $831.10 | $1,726.13 |
- 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
- $1,176.58 / $1,176.58 / $1,235.41
| Professional | | $1,176.58 | $1,176.58 | $1,235.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,060.88 / $1,060.88 / $1,060.88
| Professional | | $1,060.88 | $1,060.88 | $1,060.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,022.47 / $6,933.23 / $6,933.23
| Facility | | $3,022.47 | $6,933.23 | $6,933.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.96 / $724.97 / $1,419.12
| Professional | | $552.96 | $724.97 | $1,419.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.38 / $776.78 / $1,419.12
| Professional | | $562.38 | $776.78 | $1,419.12 |