- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.39 / $719.39 / $719.39
| Facility | | $719.39 | $719.39 | $719.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.39 / $719.39 / $1,204.02
| Professional | | $719.39 | $719.39 | $1,204.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.35 / $3,003.71 / $8,339.10
| Facility | | $952.35 | $3,003.71 | $8,339.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.08 / $1,133.30 / $1,607.89
| Professional | | $715.08 | $1,133.30 | $1,607.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.56 / $2,126.11 / $2,738.02
| Facility | | $1,747.56 | $2,126.11 | $2,738.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.93 / $1,460.88 / $1,460.88
| Professional | | $1,185.93 | $1,460.88 | $1,460.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $952.35 / $1,154.26
| Facility | | $895.00 | $952.35 | $1,154.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.35 / $895.00 / $2,020.88
| Professional | | $653.35 | $895.00 | $2,020.88 |
- 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
- $1,333.07 / $1,333.07 / $1,399.72
| Professional | | $1,333.07 | $1,333.07 | $1,399.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.00 / $910.00 / $910.00
| Professional | | $910.00 | $910.00 | $910.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,538.80 / $8,339.10 / $8,339.10
| Facility | | $3,538.80 | $8,339.10 | $8,339.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.16 / $880.10 / $1,607.89
| Professional | | $643.16 | $880.10 | $1,607.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.53 / $880.10 / $1,576.18
| Professional | | $680.53 | $880.10 | $1,576.18 |