- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.63 / $561.63 / $561.63
| Facility | | $561.63 | $561.63 | $561.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.53 / $561.63 / $1,000.83
| Professional | | $527.53 | $561.63 | $1,000.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.53 / $1,026.04 / $2,778.28
| Facility | | $533.53 | $1,026.04 | $2,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $584.90 / $2,196.32
| Professional | | $350.94 | $584.90 | $2,196.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.96 / $1,641.58 / $3,078.83
| Facility | | $1,147.96 | $1,641.58 | $3,078.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.04 / $754.19 / $754.19
| Professional | | $579.04 | $754.19 | $754.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.71 / $565.85 / $1,330.67
| Facility | | $408.71 | $565.85 | $1,330.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.78 / $671.95 / $1,524.63
| Professional | | $351.78 | $671.95 | $1,524.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,504.00 / $9,239.00
| Facility | | $83.43 | $3,504.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.88 / $843.88 / $992.80
| Professional | | $843.88 | $843.88 | $992.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.90 / $584.90 / $1,901.95
| Professional | | $584.90 | $584.90 | $1,901.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.04 / $2,778.28 / $2,778.28
| Facility | | $1,026.04 | $2,778.28 | $2,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.82 / $481.40 / $2,924.50
| Professional | | $280.82 | $481.40 | $2,924.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.75 / $350.94 / $1,208.86
| Professional | | $280.75 | $350.94 | $1,208.86 |