- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.65 / $557.94 / $804.57
| Facility | | $557.65 | $557.94 | $804.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.65 / $663.69 / $1,013.75
| Professional | | $557.65 | $663.69 | $1,013.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $1,707.73 / $1,975.94
| Facility | | $818.35 | $1,707.73 | $1,975.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.61 / $1,030.79 / $4,811.54
| Professional | | $610.61 | $1,030.79 | $4,811.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.77 / $1,359.54 / $2,381.40
| Facility | | $663.77 | $1,359.54 | $2,381.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.36 / $1,405.25 / $2,484.62
| Facility | | $570.36 | $1,405.25 | $2,484.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.00 / $1,455.12 / $2,557.28
| Professional | | $896.00 | $1,455.12 | $2,557.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.54 / $586.42 / $8,090.00
| Facility | | $346.54 | $586.42 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.57 / $688.19 / $1,313.67
| Professional | | $456.57 | $688.19 | $1,313.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.17 / $1,781.66 / $2,467.09
| Professional | | $980.17 | $1,781.66 | $2,467.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,707.73 / $5,563.56 / $5,563.56
| Facility | | $1,707.73 | $5,563.56 | $5,563.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.88 / $1,043.08 / $4,811.54
| Professional | | $668.88 | $1,043.08 | $4,811.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.29 / $928.93 / $1,796.55
| Professional | | $626.29 | $928.93 | $1,796.55 |