- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.83 / $408.83 / $567.42
| Facility | | $408.83 | $408.83 | $567.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.83 / $479.66 / $721.32
| Professional | | $408.83 | $479.66 | $721.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.20 / $1,148.53 / $1,403.98
| Facility | | $633.20 | $1,148.53 | $1,403.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.02 / $732.05 / $3,419.43
| Professional | | $433.02 | $732.05 | $3,419.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.86 / $1,002.89 / $1,756.69
| Facility | | $533.86 | $1,002.89 | $1,756.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.36 / $1,323.70 / $2,484.62
| Facility | | $570.36 | $1,323.70 | $2,484.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.00 / $1,019.18 / $1,819.05
| Professional | | $624.00 | $1,019.18 | $1,819.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.23 / $445.44 / $8,090.00
| Facility | | $263.23 | $445.44 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.20 / $484.00 / $927.81
| Professional | | $342.20 | $484.00 | $927.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.18 / $1,254.54 / $1,737.18
| Professional | | $690.18 | $1,254.54 | $1,737.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.68 / $5,563.56 / $5,563.56
| Facility | | $1,203.68 | $5,563.56 | $5,563.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.41 / $741.42 / $3,419.43
| Professional | | $477.41 | $741.42 | $3,419.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.41 / $708.99 / $1,432.65
| Professional | | $477.41 | $708.99 | $1,432.65 |