- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.54 / $607.54 / $607.54
| Facility | | $607.54 | $607.54 | $607.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.54 / $607.54 / $782.95
| Professional | | $607.54 | $607.54 | $782.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,691.81 / $6,604.88
| Facility | | $818.35 | $2,691.81 | $6,604.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.42 / $853.13 / $1,357.91
| Professional | | $509.42 | $853.13 | $1,357.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,475.87 / $1,795.56 / $2,312.35
| Facility | | $1,475.87 | $1,795.56 | $2,312.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.57 / $1,272.06 / $1,272.06
| Professional | | $1,001.57 | $1,272.06 | $1,272.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.23 / $804.29 / $974.82
| Facility | | $769.23 | $804.29 | $974.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.54 / $769.23 / $1,567.88
| Professional | | $561.54 | $769.23 | $1,567.88 |
- 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
- $1,125.82 / $1,125.82 / $1,182.10
| Professional | | $1,125.82 | $1,125.82 | $1,182.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.31 / $918.17 / $918.17
| Professional | | $811.31 | $918.17 | $918.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,745.45 / $6,604.88 / $6,604.88
| Facility | | $2,745.45 | $6,604.88 | $6,604.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.47 / $693.70 / $1,357.91
| Professional | | $462.47 | $693.70 | $1,357.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.47 / $693.70 / $1,164.95
| Professional | | $462.47 | $693.70 | $1,164.95 |