- 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
- $481.94 / $601.65 / $808.30
| Professional | | $481.94 | $601.65 | $808.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.16 / $2,539.46 / $3,899.19
| Facility | | $805.16 | $2,539.46 | $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
- $1,453.59 / $1,776.99 / $2,279.67
| Facility | | $1,453.59 | $1,776.99 | $2,279.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.83 / $890.83 / $948.40
| Professional | | $890.83 | $890.83 | $948.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $854.15 / $854.15 / $854.15
| Facility | | $854.15 | $854.15 | $854.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.53 / $854.15 / $1,021.13
| Professional | | $623.53 | $854.15 | $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
- $692.54 / $692.54 / $692.54
| Professional | | $692.54 | $692.54 | $692.54 |
- 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 / $686.96 / $1,080.91
| Professional | | $494.39 | $686.96 | $1,080.91 |