- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.17 / $515.17 / $515.17
| Facility | | $515.17 | $515.17 | $515.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.17 / $515.57 / $663.91
| Professional | | $515.17 | $515.57 | $663.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.32 / $1,853.13 / $6,597.23
| Facility | | $587.32 | $1,853.13 | $6,597.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.86 / $824.20 / $1,151.45
| Professional | | $471.86 | $824.20 | $1,151.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,251.49 / $1,522.58 / $1,960.79
| Facility | | $1,251.49 | $1,522.58 | $1,960.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.28 / $908.99 / $908.99
| Professional | | $849.28 | $908.99 | $908.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.00 / $740.83 / $826.60
| Facility | | $682.00 | $740.83 | $826.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.80 / $740.83 / $1,218.75
| Professional | | $540.80 | $740.83 | $1,218.75 |
- 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
- $954.65 / $954.65 / $1,002.38
| Professional | | $954.65 | $954.65 | $1,002.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.81 / $661.81 / $661.81
| Professional | | $661.81 | $661.81 | $661.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,864.98 / $6,597.23 / $6,597.23
| Facility | | $2,864.98 | $6,597.23 | $6,597.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.07 / $588.23 / $1,151.45
| Professional | | $433.07 | $588.23 | $1,151.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.44 / $618.15 / $1,151.45
| Professional | | $440.44 | $618.15 | $1,151.45 |