- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.53 / $836.53 / $836.53
| Facility | | $836.53 | $836.53 | $836.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.57 / $836.53 / $836.53
| Professional | | $535.57 | $836.53 | $836.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.63 / $1,285.04 / $1,692.77
| Facility | | $1,037.63 | $1,285.04 | $1,692.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.15 / $1,143.74 / $1,203.94
| Professional | | $963.15 | $1,143.74 | $1,203.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.81 / $3,715.07 / $10,318.29
| Facility | | $711.81 | $3,715.07 | $10,318.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,395.75 / $1,479.50 / $1,772.60
| Professional | | $1,395.75 | $1,479.50 | $1,772.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,205.59 / $3,564.43 / $8,124.64
| Facility | | $2,205.59 | $3,564.43 | $8,124.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,395.75 / $1,395.75 / $1,436.40
| Professional | | $1,395.75 | $1,395.75 | $1,436.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.73 / $1,203.94 / $5,716.25
| Facility | | $357.73 | $1,203.94 | $5,716.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.66 / $539.86 / $1,322.57
| Professional | | $358.66 | $539.86 | $1,322.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.66 / $537.98 / $1,208.97
| Professional | | $358.66 | $537.98 | $1,208.97 |