- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.58 / $3,739.65 / $4,749.35
| Facility | | $998.58 | $3,739.65 | $4,749.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,519.67 / $3,739.65 / $3,739.65
| Professional | | $3,519.67 | $3,739.65 | $3,739.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.55 / $424.18 / $8,459.92
| Facility | | $360.55 | $424.18 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.18 / $424.18 / $424.18
| Professional | | $424.18 | $424.18 | $424.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,739.65 / $3,739.65 / $3,739.65
| Facility | | $3,739.65 | $3,739.65 | $3,739.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,739.65 / $3,739.65 / $3,739.65
| Professional | | $3,739.65 | $3,739.65 | $3,739.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.53 / $379.53 / $379.53
| Professional | | $379.53 | $379.53 | $379.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,211.33 / $3,211.33 / $3,211.33
| Facility | | $3,211.33 | $3,211.33 | $3,211.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.58 / $3,739.65 / $5,347.70
| Facility | | $998.58 | $3,739.65 | $5,347.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,519.67 / $3,739.65 / $4,749.35
| Professional | | $3,519.67 | $3,739.65 | $4,749.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,739.65 / $3,739.65 / $3,739.65
| Facility | | $3,739.65 | $3,739.65 | $3,739.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,739.65 / $3,739.65 / $3,739.65
| Professional | | $3,739.65 | $3,739.65 | $3,739.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.18 / $424.18 / $466.60
| Facility | | $424.18 | $424.18 | $466.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.18 / $424.18 / $466.60
| Professional | | $424.18 | $424.18 | $466.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,666.33 / $3,666.33 / $4,784.56
| Professional | | $3,666.33 | $3,666.33 | $4,784.56 |