- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.45 / $558.45 / $558.45
| Facility | | $558.45 | $558.45 | $558.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.45 / $582.20 / $964.91
| Professional | | $558.45 | $582.20 | $964.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.09 / $2,139.54 / $7,656.34
| Facility | | $678.09 | $2,139.54 | $7,656.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.61 / $929.36 / $1,248.18
| Professional | | $547.61 | $929.36 | $1,248.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.60 / $1,650.46 / $2,125.48
| Facility | | $1,356.60 | $1,650.46 | $2,125.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.93 / $985.34 / $985.34
| Professional | | $836.93 | $985.34 | $985.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.29 / $755.39 / $896.05
| Facility | | $739.29 | $755.39 | $896.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.42 / $755.38 / $1,741.88
| Professional | | $551.42 | $755.38 | $1,741.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.83 / $1,034.83 / $1,086.58
| Professional | | $1,034.83 | $1,034.83 | $1,086.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.08 / $799.08 / $799.08
| Professional | | $799.08 | $799.08 | $799.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,049.95 / $7,656.34 / $7,656.34
| Facility | | $3,049.95 | $7,656.34 | $7,656.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.62 / $637.64 / $1,248.18
| Professional | | $486.62 | $637.64 | $1,248.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.15 / $683.21 / $1,248.18
| Professional | | $511.15 | $683.21 | $1,248.18 |