- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.91 / $1,233.35 / $3,727.52
| Facility | | $635.91 | $1,233.35 | $3,727.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.21 / $635.91 / $781.28
| Professional | | $424.21 | $635.91 | $781.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.33 / $1,082.40 / $2,794.89
| Facility | | $710.33 | $1,082.40 | $2,794.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.85 / $1,321.55 / $5,073.75
| Professional | | $608.85 | $1,321.55 | $5,073.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.32 / $1,438.05 / $1,978.79
| Facility | | $681.32 | $1,438.05 | $1,978.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.61 / $745.21 / $922.92
| Professional | | $357.61 | $745.21 | $922.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.50 / $893.70 / $2,092.69
| Facility | | $676.50 | $893.70 | $2,092.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.50 / $1,012.95 / $1,872.26
| Professional | | $676.50 | $1,012.95 | $1,872.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $662.29 / $717.88
| Professional | | $75.00 | $662.29 | $717.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.50 / $676.50 / $1,420.65
| Facility | | $676.50 | $676.50 | $1,420.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.50 / $1,188.85 / $2,029.50
| Facility | | $676.50 | $1,188.85 | $2,029.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.85 / $845.63 / $1,021.52
| Professional | | $608.85 | $845.63 | $1,021.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.33 / $1,110.14 / $1,860.38
| Facility | | $710.33 | $1,110.14 | $1,860.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.21 / $1,316.61 / $1,572.77
| Professional | | $748.21 | $1,316.61 | $1,572.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.13 / $327.64 / $757.68
| Professional | | $284.13 | $327.64 | $757.68 |