- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Facility | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $1,412.54
| Professional | | $457.09 | $630.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,995.26 / $3,981.07
| Facility | | $1,659.59 | $1,995.26 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $912.01 / $3,981.07
| Professional | | $380.19 | $912.01 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,621.81 / $2,187.76
| Facility | | $1,318.26 | $1,621.81 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $1,000.00 / $2,511.89
| Facility | | $239.88 | $1,000.00 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,047.13 / $2,041.74
| Professional | | $489.78 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $912.01 / $7,079.46
| Facility | | $208.93 | $912.01 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $501.19 / $1,174.90
| Professional | | $186.21 | $501.19 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,380.38 / $2,187.76
| Professional | | $794.33 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,995.26 / $3,981.07
| Facility | | $1,659.59 | $1,995.26 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $954.99 / $3,981.07
| Professional | | $380.19 | $954.99 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,548.82 / $2,818.38
| Facility | | $181.97 | $1,548.82 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $954.99 / $2,238.72
| Professional | | $380.19 | $954.99 | $2,238.72 |