- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.46 / $517.46 / $517.46
| Facility | | $517.46 | $517.46 | $517.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.46 / $517.46 / $954.29
| Professional | | $517.46 | $517.46 | $954.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.71 / $1,990.47 / $6,185.97
| Facility | | $640.71 | $1,990.47 | $6,185.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.63 / $853.97 / $1,156.56
| Professional | | $540.63 | $853.97 | $1,156.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.04 / $1,529.33 / $1,969.49
| Facility | | $1,257.04 | $1,529.33 | $1,969.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.51 / $1,050.83 / $1,050.83
| Professional | | $775.51 | $1,050.83 | $1,050.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.04 / $870.47 / $875.29
| Facility | | $685.04 | $870.47 | $875.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.96 / $875.29 / $1,568.63
| Professional | | $638.96 | $875.29 | $1,568.63 |
- 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
- $958.89 / $958.89 / $1,006.83
| Professional | | $958.89 | $958.89 | $1,006.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.87 / $733.87 / $733.87
| Professional | | $733.87 | $733.87 | $733.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,746.77 / $6,185.97 / $6,185.97
| Facility | | $2,746.77 | $6,185.97 | $6,185.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.62 / $633.07 / $1,156.56
| Professional | | $462.62 | $633.07 | $1,156.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.52 / $633.07 / $1,083.67
| Professional | | $489.52 | $633.07 | $1,083.67 |