- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.16 / $557.16 / $557.16
| Facility | | $557.16 | $557.16 | $557.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.16 / $557.16 / $936.88
| Professional | | $557.16 | $557.16 | $936.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.92 / $3,598.46 / $5,705.72
| Facility | | $1,140.92 | $3,598.46 | $5,705.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.83 / $919.49 / $1,245.30
| Professional | | $553.83 | $919.49 | $1,245.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.48 / $1,646.67 / $2,120.60
| Facility | | $1,353.48 | $1,646.67 | $2,120.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.01 / $1,131.46 / $1,131.46
| Professional | | $835.01 | $1,131.46 | $1,131.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.60 / $937.25 / $957.73
| Facility | | $737.60 | $937.25 | $957.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.14 / $957.73 / $1,565.25
| Professional | | $699.14 | $957.73 | $1,565.25 |
- 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
- $1,032.47 / $1,032.47 / $1,084.08
| Professional | | $1,032.47 | $1,032.47 | $1,084.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.93 / $715.93 / $715.93
| Professional | | $715.93 | $715.93 | $715.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.74 / $5,705.72 / $5,705.72
| Facility | | $2,740.74 | $5,705.72 | $5,705.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.12 / $681.64 / $1,245.30
| Professional | | $498.12 | $681.64 | $1,245.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.23 / $595.23 / $595.23
| Facility | | $595.23 | $595.23 | $595.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.07 / $681.64 / $1,220.75
| Professional | | $527.07 | $681.64 | $1,220.75 |