- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.09 / $881.09 / $881.09
| Facility | | $881.09 | $881.09 | $881.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.32 / $904.08 / $2,648.80
| Professional | | $718.32 | $904.08 | $2,648.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,947.44 / $4,308.96 / $4,308.96
| Facility | | $1,947.44 | $4,308.96 | $4,308.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.09 / $1,551.93 / $8,114.99
| Professional | | $889.09 | $1,551.93 | $8,114.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.13 / $1,647.74 / $2,232.25
| Professional | | $1,065.13 | $1,647.74 | $2,232.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.16 / $1,020.16 / $1,020.16
| Facility | | $1,020.16 | $1,020.16 | $1,020.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.40 / $1,376.57 / $2,433.27
| Professional | | $870.40 | $1,376.57 | $2,433.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.53 / $1,041.53 / $1,041.53
| Facility | | $1,041.53 | $1,041.53 | $1,041.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.86 / $928.20 / $1,592.55
| Professional | | $503.86 | $928.20 | $1,592.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.11 / $2,132.16 / $2,753.23
| Professional | | $1,080.11 | $2,132.16 | $2,753.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,515.44 / $1,515.44 / $1,515.44
| Facility | | $1,515.44 | $1,515.44 | $1,515.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.55 / $1,510.04 / $2,766.25
| Professional | | $1,387.55 | $1,510.04 | $2,766.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,947.44 / $4,308.96 / $4,308.96
| Facility | | $1,947.44 | $4,308.96 | $4,308.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.05 / $1,427.00 / $8,114.99
| Professional | | $967.05 | $1,427.00 | $8,114.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.28 / $1,289.65 / $2,384.69
| Professional | | $935.28 | $1,289.65 | $2,384.69 |