- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.07 / $767.07 / $767.07
| Facility | | $767.07 | $767.07 | $767.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.07 / $767.07 / $1,295.80
| Professional | | $767.07 | $767.07 | $1,295.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $940.73 / $2,967.06 / $9,722.68
| Facility | | $940.73 | $2,967.06 | $9,722.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.04 / $1,219.69 / $1,714.47
| Professional | | $769.04 | $1,219.69 | $1,714.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,863.40 / $2,267.04 / $2,919.52
| Facility | | $1,863.40 | $2,267.04 | $2,919.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.59 / $1,557.71 / $1,557.71
| Professional | | $1,149.59 | $1,557.71 | $1,557.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.22 / $1,015.49 / $1,230.79
| Facility | | $963.22 | $1,015.49 | $1,230.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.15 / $963.22 / $2,064.00
| Professional | | $703.15 | $963.22 | $2,064.00 |
- 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
- $1,421.44 / $1,421.44 / $1,492.51
| Professional | | $1,421.44 | $1,421.44 | $1,492.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.37 / $979.37 / $979.37
| Professional | | $979.37 | $979.37 | $979.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,613.87 / $9,722.68 / $9,722.68
| Facility | | $3,613.87 | $9,722.68 | $9,722.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.79 / $938.45 / $1,714.47
| Professional | | $685.79 | $938.45 | $1,714.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.04 / $1,265.91 / $1,541.50
| Professional | | $769.04 | $1,265.91 | $1,541.50 |