- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $645.65 / $1,122.02
| Professional | | $489.78 | $645.65 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,258.93 / $5,754.40
| Facility | | $1,202.26 | $1,258.93 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $977.24 / $1,318.26
| Professional | | $549.54 | $977.24 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,659.59 / $2,187.76
| Facility | | $1,380.38 | $1,659.59 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $1,122.02
| Professional | | $831.76 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $933.25 / $954.99
| Facility | | $741.31 | $933.25 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $954.99
| Professional | | $691.83 | $691.83 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,698.24
| Professional | | $1,122.02 | $1,122.02 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Professional | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,258.93 / $5,754.40
| Facility | | $1,202.26 | $1,258.93 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $977.24 / $1,445.44
| Professional | | $562.34 | $977.24 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.87 / $812.83 / $1,479.11
| Facility | | $0.87 | $812.83 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $812.83 / $1,122.02
| Professional | | $524.81 | $812.83 | $1,122.02 |