- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $697.57 / $697.57 / $697.57
| Facility | | $697.57 | $697.57 | $697.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.57 / $697.57 / $898.95
| Professional | | $697.57 | $697.57 | $898.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.20 / $2,813.40 / $8,075.38
| Facility | | $849.20 | $2,813.40 | $8,075.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $622.84 / $1,008.87 / $1,559.10
| Professional | | $622.84 | $1,008.87 | $1,559.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,694.54 / $2,061.61 / $2,654.96
| Facility | | $1,694.54 | $2,061.61 | $2,654.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.42 / $1,230.79 / $1,230.79
| Professional | | $1,045.42 | $1,230.79 | $1,230.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.47 / $1,057.34 / $1,119.25
| Facility | | $923.47 | $1,057.34 | $1,119.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.87 / $1,057.34 / $1,739.63
| Professional | | $771.87 | $1,057.34 | $1,739.63 |
- 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
- $1,292.64 / $1,292.64 / $1,357.27
| Professional | | $1,292.64 | $1,292.64 | $1,357.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.13 / $811.13 / $811.13
| Professional | | $811.13 | $811.13 | $811.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,071.82 / $8,075.38 / $8,075.38
| Facility | | $3,071.82 | $8,075.38 | $8,075.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.99 / $796.49 / $1,559.10
| Professional | | $530.99 | $796.49 | $1,559.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.13 / $796.49 / $1,309.22
| Professional | | $539.13 | $796.49 | $1,309.22 |