- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.19 / $806.19 / $806.19
| Facility | | $806.19 | $806.19 | $806.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.96 / $800.98 / $985.67
| Professional | | $658.96 | $800.98 | $985.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.90 / $1,127.58 / $2,493.33
| Facility | | $539.90 | $1,127.58 | $2,493.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.72 / $1,139.99 / $4,680.93
| Professional | | $254.72 | $1,139.99 | $4,680.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.17 / $857.91 / $1,074.51
| Facility | | $705.17 | $857.91 | $1,074.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.18 / $928.60 / $1,274.09
| Facility | | $772.18 | $928.60 | $1,274.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.84 / $1,407.20 / $2,419.59
| Professional | | $841.84 | $1,407.20 | $2,419.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.26 / $1,221.42 / $8,090.00
| Facility | | $718.26 | $1,221.42 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.66 / $793.92 / $1,300.41
| Professional | | $442.66 | $793.92 | $1,300.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.39 / $1,775.53 / $2,337.15
| Professional | | $938.39 | $1,775.53 | $2,337.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,587.78 / $1,587.78 / $3,967.91
| Facility | | $1,587.78 | $1,587.78 | $3,967.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.01 / $1,136.61 / $4,680.93
| Professional | | $565.01 | $1,136.61 | $4,680.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.45 / $1,007.35 / $1,913.56
| Professional | | $558.45 | $1,007.35 | $1,913.56 |