- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.65 / $601.65 / $601.65
| Facility | | $601.65 | $601.65 | $601.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.92 / $601.65 / $844.28
| Professional | | $447.92 | $601.65 | $844.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.79 / $2,191.37 / $3,899.19
| Facility | | $694.79 | $2,191.37 | $3,899.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.39 / $862.18 / $1,063.03
| Professional | | $494.39 | $862.18 | $1,063.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,478.55 / $1,778.12 / $2,289.89
| Facility | | $1,478.55 | $1,778.12 | $2,289.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.69 / $1,354.04 / $1,702.19
| Professional | | $902.69 | $1,354.04 | $1,702.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $952.31
| Facility | | $812.83 | $812.83 | $952.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.37 / $812.83 / $1,021.13
| Professional | | $593.37 | $812.83 | $1,021.13 |
- 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
- $1,114.88 / $1,114.88 / $1,170.61
| Professional | | $1,114.88 | $1,114.88 | $1,170.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.94 / $715.94 / $862.18
| Professional | | $715.94 | $715.94 | $862.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,830.35 / $3,899.19 / $3,899.19
| Facility | | $1,830.35 | $3,899.19 | $3,899.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.39 / $686.96 / $1,077.73
| Professional | | $494.39 | $686.96 | $1,077.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.39 / $734.15 / $1,080.91
| Professional | | $494.39 | $734.15 | $1,080.91 |