- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.02 / $466.02 / $466.02
| Facility | | $466.02 | $466.02 | $466.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.02 / $466.02 / $747.45
| Professional | | $466.02 | $466.02 | $747.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.25 / $2,364.94 / $5,149.18
| Facility | | $761.25 | $2,364.94 | $5,149.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.77 / $761.25 / $1,041.57
| Professional | | $477.77 | $761.25 | $1,041.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,132.06 / $1,377.28 / $1,773.68
| Facility | | $1,132.06 | $1,377.28 | $1,773.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.24 / $946.34 / $946.34
| Professional | | $768.24 | $946.34 | $946.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.92 / $694.09 / $747.73
| Facility | | $616.92 | $694.09 | $747.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.69 / $694.09 / $1,363.50
| Professional | | $506.69 | $694.09 | $1,363.50 |
- 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
- $863.56 / $863.56 / $906.74
| Professional | | $863.56 | $863.56 | $906.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.42 / $608.42 / $608.42
| Facility | | $608.42 | $608.42 | $608.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.42 / $608.42 / $702.50
| Professional | | $608.42 | $608.42 | $702.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,387.36 / $5,149.18 / $5,149.18
| Facility | | $2,387.36 | $5,149.18 | $5,149.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.63 / $570.12 / $1,041.57
| Professional | | $416.63 | $570.12 | $1,041.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.77 / $809.44 / $957.66
| Professional | | $477.77 | $809.44 | $957.66 |