- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.88 / $636.88 / $636.88
| Facility | | $636.88 | $636.88 | $636.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.88 / $671.72 / $1,171.21
| Professional | | $636.88 | $671.72 | $1,171.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.05 / $3,373.20 / $7,270.11
| Facility | | $1,130.05 | $3,373.20 | $7,270.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.33 / $1,109.92 / $1,423.47
| Professional | | $673.33 | $1,109.92 | $1,423.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.58 / $1,882.26 / $2,424.00
| Facility | | $1,591.58 | $1,882.26 | $2,424.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.52 / $1,215.26 / $1,215.26
| Professional | | $1,073.52 | $1,215.26 | $1,215.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.35 / $843.35 / $843.35
| Facility | | $843.35 | $843.35 | $843.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.85 / $843.35 / $1,779.00
| Professional | | $716.85 | $843.35 | $1,779.00 |
- 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
- $1,180.19 / $1,180.19 / $1,239.20
| Professional | | $1,180.19 | $1,180.19 | $1,239.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,114.91 / $7,270.11 / $7,270.11
| Facility | | $3,114.91 | $7,270.11 | $7,270.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.39 / $876.34 / $1,423.47
| Professional | | $569.39 | $876.34 | $1,423.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,799.54 / $1,799.54 / $1,799.54
| Facility | | $1,799.54 | $1,799.54 | $1,799.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.60 / $876.34 / $1,423.47
| Professional | | $656.60 | $876.34 | $1,423.47 |