- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.19 / $677.19 / $677.19
| Facility | | $677.19 | $677.19 | $677.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.19 / $714.24 / $1,233.29
| Professional | | $677.19 | $714.24 | $1,233.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.70 / $4,139.30 / $7,396.37
| Facility | | $1,386.70 | $4,139.30 | $7,396.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.89 / $1,151.64 / $1,513.57
| Professional | | $707.89 | $1,151.64 | $1,513.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,692.30 / $2,001.39 / $2,577.41
| Facility | | $1,692.30 | $2,001.39 | $2,577.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.36 / $1,375.18 / $1,375.18
| Professional | | $1,116.36 | $1,375.18 | $1,375.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.63 / $886.63 / $1,139.15
| Facility | | $886.63 | $886.63 | $1,139.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.24 / $886.63 / $1,840.88
| Professional | | $647.24 | $886.63 | $1,840.88 |
- 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
- $1,254.88 / $1,254.88 / $1,317.62
| Professional | | $1,254.88 | $1,254.88 | $1,317.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.49 / $1,131.49 / $1,131.49
| Professional | | $1,131.49 | $1,131.49 | $1,131.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,223.60 / $7,396.37 / $7,396.37
| Facility | | $3,223.60 | $7,396.37 | $7,396.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.42 / $828.47 / $1,513.57
| Professional | | $605.42 | $828.47 | $1,513.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.13 / $828.47 / $1,513.57
| Professional | | $673.13 | $828.47 | $1,513.57 |