- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.25 / $642.25 / $642.25
| Facility | | $642.25 | $642.25 | $642.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.25 / $686.30 / $1,289.61
| Professional | | $642.25 | $686.30 | $1,289.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.73 / $1,972.70 / $7,691.82
| Facility | | $656.73 | $1,972.70 | $7,691.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.13 / $1,123.34 / $1,435.47
| Professional | | $662.13 | $1,123.34 | $1,435.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,560.17 / $1,898.12 / $2,444.42
| Facility | | $1,560.17 | $1,898.12 | $2,444.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,058.77 / $1,304.23 / $1,304.23
| Professional | | $1,058.77 | $1,304.23 | $1,304.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.23 / $913.06 / $1,030.49
| Facility | | $850.23 | $913.06 | $1,030.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.53 / $913.06 / $2,241.00
| Professional | | $666.53 | $913.06 | $2,241.00 |
- 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
- $1,190.13 / $1,190.13 / $1,249.64
| Professional | | $1,190.13 | $1,190.13 | $1,249.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.68 / $974.68 / $974.68
| Professional | | $974.68 | $974.68 | $974.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,924.31 / $7,691.82 / $7,691.82
| Facility | | $3,924.31 | $7,691.82 | $7,691.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.50 / $819.51 / $1,435.47
| Professional | | $607.50 | $819.51 | $1,435.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.40 / $819.51 / $1,435.47
| Professional | | $638.40 | $819.51 | $1,435.47 |