- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.54 / $641.54 / $641.54
| Facility | | $641.54 | $641.54 | $641.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.54 / $694.49 / $940.41
| Professional | | $641.54 | $694.49 | $940.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.01 / $3,796.73 / $7,005.45
| Facility | | $1,146.01 | $3,796.73 | $7,005.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.77 / $1,090.75 / $1,433.91
| Professional | | $608.77 | $1,090.75 | $1,433.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.24 / $1,896.05 / $2,441.76
| Facility | | $1,603.24 | $1,896.05 | $2,441.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.46 / $961.46 / $1,067.08
| Professional | | $961.46 | $961.46 | $1,067.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,038.85 / $1,038.85 / $1,079.19
| Facility | | $1,038.85 | $1,038.85 | $1,079.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.37 / $1,038.85 / $1,744.13
| Professional | | $758.37 | $1,038.85 | $1,744.13 |
- 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
- $1,188.83 / $1,188.83 / $1,248.28
| Professional | | $1,188.83 | $1,188.83 | $1,248.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.88 / $851.88 / $851.88
| Professional | | $851.88 | $851.88 | $851.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,053.89 / $7,005.45 / $7,005.45
| Facility | | $3,053.89 | $7,005.45 | $7,005.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.72 / $732.53 / $1,433.91
| Professional | | $558.72 | $732.53 | $1,433.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.24 / $784.86 / $1,433.91
| Professional | | $568.24 | $784.86 | $1,433.91 |