- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.54 / $1,375.19 / $1,822.19
| Facility | | $418.54 | $1,375.19 | $1,822.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.13 / $418.54 / $484.31
| Professional | | $393.13 | $418.54 | $484.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.35 / $2,840.07 / $2,840.07
| Facility | | $1,040.35 | $2,840.07 | $2,840.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.75 / $358.75 / $2,989.55
| Professional | | $358.75 | $358.75 | $2,989.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.33 / $1,358.97 / $2,375.83
| Facility | | $950.33 | $1,358.97 | $2,375.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.68 / $432.01 / $1,360.24
| Facility | | $384.68 | $432.01 | $1,360.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.78 / $728.03 / $872.26
| Professional | | $349.78 | $728.03 | $872.26 |
- 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
- $862.55 / $862.55 / $1,014.77
| Professional | | $862.55 | $862.55 | $1,014.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.91 / $597.91 / $1,944.25
| Professional | | $597.91 | $597.91 | $1,944.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.35 / $2,840.07 / $2,840.07
| Facility | | $1,040.35 | $2,840.07 | $2,840.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.75 / $358.75 / $2,989.55
| Professional | | $358.75 | $358.75 | $2,989.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $538.12 / $597.91 / $717.49
| Facility | | $538.12 | $597.91 | $717.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.75 / $358.75 / $1,235.76
| Professional | | $358.75 | $358.75 | $1,235.76 |