- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.48 / $671.48 / $671.48
| Facility | | $671.48 | $671.48 | $671.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.80 / $671.48 / $968.90
| Professional | | $562.80 | $671.48 | $968.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $2,598.40 / $7,299.94
| Facility | | $1,017.00 | $2,598.40 | $7,299.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.32 / $1,026.86 / $1,500.81
| Professional | | $600.32 | $1,026.86 | $1,500.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,631.19 / $1,984.53 / $2,555.69
| Facility | | $1,631.19 | $1,984.53 | $2,555.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.33 / $1,363.60 / $1,363.60
| Professional | | $1,006.33 | $1,363.60 | $1,363.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.21 / $888.94 / $1,077.40
| Facility | | $812.21 | $888.94 | $1,077.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.91 / $812.21 / $1,336.13
| Professional | | $592.91 | $812.21 | $1,336.13 |
- 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
- $1,244.30 / $1,244.30 / $1,306.52
| Professional | | $1,244.30 | $1,244.30 | $1,306.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.30 / $732.30 / $732.30
| Professional | | $732.30 | $732.30 | $732.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,598.40 / $7,299.94 / $7,299.94
| Facility | | $2,598.40 | $7,299.94 | $7,299.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.03 / $821.50 / $1,500.81
| Professional | | $575.03 | $821.50 | $1,500.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.11 / $821.50 / $1,366.08
| Professional | | $585.11 | $821.50 | $1,366.08 |