- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.25 / $654.25 / $654.25
| Facility | | $654.25 | $654.25 | $654.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.25 / $654.25 / $845.04
| Professional | | $654.25 | $654.25 | $845.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,695.46 / $8,437.95
| Facility | | $818.35 | $2,695.46 | $8,437.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.52 / $1,054.17 / $1,462.28
| Professional | | $603.52 | $1,054.17 | $1,462.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,589.30 / $1,933.57 / $2,490.07
| Facility | | $1,589.30 | $1,933.57 | $2,490.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.50 / $1,012.59 / $1,012.59
| Professional | | $980.50 | $1,012.59 | $1,012.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.50 / $866.11 / $1,049.74
| Facility | | $832.50 | $866.11 | $1,049.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.73 / $832.50 / $1,761.38
| Professional | | $607.73 | $832.50 | $1,761.38 |
- 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
- $1,212.35 / $1,212.35 / $1,272.98
| Professional | | $1,212.35 | $1,212.35 | $1,272.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.46 / $846.46 / $846.46
| Professional | | $846.46 | $846.46 | $846.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,084.52 / $8,437.95 / $8,437.95
| Facility | | $3,084.52 | $8,437.95 | $8,437.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.90 / $747.02 / $1,462.28
| Professional | | $553.90 | $747.02 | $1,462.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.33 / $790.63 / $1,462.28
| Professional | | $563.33 | $790.63 | $1,462.28 |