- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.73 / $708.73 / $708.73
| Facility | | $708.73 | $708.73 | $708.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.89 / $708.73 / $1,265.04
| Professional | | $681.89 | $708.73 | $1,265.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.46 / $1,320.27 / $8,818.61
| Facility | | $1,077.46 | $1,320.27 | $8,818.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.84 / $1,131.33 / $1,257.40
| Professional | | $614.84 | $1,131.33 | $1,257.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.81 / $182.81 / $188.14
| Facility | | $182.81 | $182.81 | $188.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.90 / $1,422.33 / $1,422.33
| Professional | | $1,187.90 | $1,422.33 | $1,422.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.06 / $902.06 / $1,570.30
| Facility | | $902.06 | $902.06 | $1,570.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.08 / $902.06 / $2,348.44
| Professional | | $139.08 | $902.06 | $2,348.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,295.53 / $1,295.53 / $1,295.53
| Professional | | $1,295.53 | $1,295.53 | $1,295.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.46 / $1,077.46 / $1,077.46
| Professional | | $1,077.46 | $1,077.46 | $1,077.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $8,818.61 / $8,818.61
| Facility | | $100.00 | $8,818.61 | $8,818.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.42 / $800.88 / $1,360.30
| Professional | | $600.42 | $800.88 | $1,360.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.93 / $547.76 / $1,054.72
| Facility | | $0.93 | $547.76 | $1,054.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.02 / $983.74 / $1,621.60
| Professional | | $601.02 | $983.74 | $1,621.60 |