- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.78 / $819.78 / $819.78
| Facility | | $819.78 | $819.78 | $819.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.78 / $819.78 / $1,305.16
| Professional | | $819.78 | $819.78 | $1,305.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,678.68 / $5,344.70 / $8,657.11
| Facility | | $1,678.68 | $5,344.70 | $8,657.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.90 / $1,342.86 / $1,832.26
| Professional | | $732.90 | $1,342.86 | $1,832.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,048.64 / $2,422.80 / $3,120.11
| Facility | | $2,048.64 | $2,422.80 | $3,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,351.44 / $1,351.44 / $1,720.29
| Professional | | $1,351.44 | $1,351.44 | $1,720.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.33 / $1,025.33 / $1,379.02
| Facility | | $1,025.33 | $1,025.33 | $1,379.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.49 / $1,025.33 / $2,109.75
| Professional | | $748.49 | $1,025.33 | $2,109.75 |
- 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
- $1,519.11 / $1,519.11 / $1,595.07
| Professional | | $1,519.11 | $1,519.11 | $1,595.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.73 / $1,296.73 / $1,296.73
| Professional | | $1,296.73 | $1,296.73 | $1,296.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,694.38 / $8,657.11 / $8,657.11
| Facility | | $3,694.38 | $8,657.11 | $8,657.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.93 / $936.04 / $1,832.26
| Professional | | $666.93 | $936.04 | $1,832.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.29 / $951.97 / $1,832.26
| Professional | | $678.29 | $951.97 | $1,832.26 |