- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.28 / $589.28 / $609.98
| Facility | | $589.28 | $589.28 | $609.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.28 / $589.28 / $3,567.08
| Professional | | $589.28 | $589.28 | $3,567.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.78 / $1,282.09 / $2,479.98
| Facility | | $974.78 | $1,282.09 | $2,479.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.44 / $1,159.14 / $1,188.10
| Professional | | $1,084.44 | $1,159.14 | $1,188.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,420.72 / $3,420.72 / $3,420.72
| Facility | | $3,420.72 | $3,420.72 | $3,420.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.00 / $1,366.07 / $1,848.11
| Professional | | $899.00 | $1,366.07 | $1,848.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.41 / $796.10 / $5,991.20
| Facility | | $294.41 | $796.10 | $5,991.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.20 / $967.23 / $4,187.89
| Professional | | $428.20 | $967.23 | $4,187.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.84 / $1,174.45 / $1,841.51
| Facility | | $503.84 | $1,174.45 | $1,841.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.04 / $1,140.68 / $1,722.22
| Professional | | $522.04 | $1,140.68 | $1,722.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.41 / $652.23 / $1,210.58
| Professional | | $91.41 | $652.23 | $1,210.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.00 / $451.00 / $477.52
| Facility | | $451.00 | $451.00 | $477.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.10 / $1,175.60 / $1,372.42
| Professional | | $605.10 | $1,175.60 | $1,372.42 |