- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.46 / $558.46 / $558.46
| Facility | | $558.46 | $558.46 | $558.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.46 / $558.46 / $944.89
| Professional | | $558.46 | $558.46 | $944.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.28 / $2,411.63 / $6,432.21
| Facility | | $776.28 | $2,411.63 | $6,432.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.78 / $889.39 / $1,248.20
| Professional | | $560.78 | $889.39 | $1,248.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.62 / $1,650.49 / $2,125.52
| Facility | | $1,356.62 | $1,650.49 | $2,125.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.65 / $1,134.08 / $1,134.08
| Professional | | $920.65 | $1,134.08 | $1,134.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.38 / $739.31 / $896.07
| Facility | | $702.38 | $739.31 | $896.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.74 / $702.38 / $1,569.00
| Professional | | $512.74 | $702.38 | $1,569.00 |
- 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
- $1,034.85 / $1,034.85 / $1,086.59
| Professional | | $1,034.85 | $1,034.85 | $1,086.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.14 / $714.14 / $714.14
| Professional | | $714.14 | $714.14 | $714.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.14 / $6,432.21 / $6,432.21
| Facility | | $2,747.14 | $6,432.21 | $6,432.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.28 / $683.22 / $1,248.20
| Professional | | $499.28 | $683.22 | $1,248.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.29 / $683.22 / $1,223.61
| Professional | | $528.29 | $683.22 | $1,223.61 |