- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.20 / $556.20 / $556.20
| Facility | | $556.20 | $556.20 | $556.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.19 / $556.20 / $802.57
| Professional | | $466.19 | $556.20 | $802.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.15 / $2,025.45 / $6,046.75
| Facility | | $966.15 | $2,025.45 | $6,046.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.26 / $966.10 / $1,243.16
| Professional | | $497.26 | $966.10 | $1,243.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.15 / $1,643.83 / $2,116.94
| Facility | | $1,351.15 | $1,643.83 | $2,116.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.93 / $1,129.50 / $1,129.50
| Professional | | $916.93 | $1,129.50 | $1,129.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.58 / $735.67 / $892.44
| Facility | | $596.58 | $735.67 | $892.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.50 / $435.50 / $1,107.00
| Professional | | $435.50 | $435.50 | $1,107.00 |
- 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
- $1,030.69 / $1,030.69 / $1,082.22
| Professional | | $1,030.69 | $1,030.69 | $1,082.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.58 / $606.58 / $606.58
| Professional | | $606.58 | $606.58 | $606.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,025.45 / $6,046.75 / $6,046.75
| Facility | | $2,025.45 | $6,046.75 | $6,046.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.31 / $680.46 / $1,243.16
| Professional | | $476.31 | $680.46 | $1,243.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.76 / $629.41 / $717.65
| Facility | | $0.76 | $629.41 | $717.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.31 / $680.46 / $1,030.69
| Professional | | $476.31 | $680.46 | $1,030.69 |