- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.75 / $763.75 / $763.75
| Facility | | $763.75 | $763.75 | $763.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.07 / $841.84 / $1,119.51
| Professional | | $595.07 | $841.84 | $1,119.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,364.30 / $4,450.35 / $8,339.85
| Facility | | $1,364.30 | $4,450.35 | $8,339.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.73 / $1,298.52 / $1,707.04
| Professional | | $724.73 | $1,298.52 | $1,707.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,908.64 / $2,257.23 / $2,906.89
| Facility | | $1,908.64 | $2,257.23 | $2,906.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.60 / $1,144.60 / $1,270.34
| Professional | | $1,144.60 | $1,144.60 | $1,270.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.20 / $1,162.20 / $1,433.06
| Facility | | $1,162.20 | $1,162.20 | $1,433.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.41 / $1,162.20 / $2,076.38
| Professional | | $848.41 | $1,162.20 | $2,076.38 |
- 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
- $1,415.29 / $1,415.29 / $1,486.05
| Professional | | $1,415.29 | $1,415.29 | $1,486.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.28 / $1,014.28 / $1,014.28
| Professional | | $1,014.28 | $1,014.28 | $1,014.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,635.67 / $8,339.85 / $8,339.85
| Facility | | $3,635.67 | $8,339.85 | $8,339.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.14 / $872.06 / $1,707.04
| Professional | | $665.14 | $872.06 | $1,707.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.48 / $934.38 / $1,707.04
| Professional | | $676.48 | $934.38 | $1,707.04 |