- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.81 / $368.81 / $643.67
| Facility | | $368.81 | $368.81 | $643.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.81 / $466.69 / $718.86
| Professional | | $368.81 | $466.69 | $718.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.32 / $1,600.37 / $2,287.05
| Facility | | $736.32 | $1,600.37 | $2,287.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.19 / $787.13 / $4,187.89
| Professional | | $246.19 | $787.13 | $4,187.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.39 / $1,002.89 / $1,756.69
| Facility | | $449.39 | $1,002.89 | $1,756.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.83 / $1,403.27 / $2,373.21
| Facility | | $617.83 | $1,403.27 | $2,373.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.32 / $1,021.37 / $2,107.96
| Professional | | $344.32 | $1,021.37 | $2,107.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.35 / $889.78 / $6,679.00
| Facility | | $497.35 | $889.78 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.42 / $765.98 / $1,199.96
| Professional | | $104.42 | $765.98 | $1,199.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.96 / $1,408.64 / $1,950.57
| Professional | | $774.96 | $1,408.64 | $1,950.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,602.32 / $5,761.44 / $5,761.44
| Facility | | $4,602.32 | $5,761.44 | $5,761.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.19 / $878.87 / $4,187.89
| Professional | | $246.19 | $878.87 | $4,187.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.48 / $749.65 / $1,792.30
| Professional | | $241.48 | $749.65 | $1,792.30 |