- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.04 / $638.04 / $638.04
| Facility | | $638.04 | $638.04 | $638.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.98 / $709.75 / $824.63
| Professional | | $516.98 | $709.75 | $824.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $747.50 / $2,358.52 / $7,970.79
| Facility | | $747.50 | $2,358.52 | $7,970.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.39 / $995.80 / $1,426.08
| Professional | | $570.39 | $995.80 | $1,426.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,549.95 / $1,885.70 / $2,417.59
| Facility | | $1,549.95 | $1,885.70 | $2,417.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.98 / $1,125.77 / $1,125.77
| Professional | | $773.98 | $1,125.77 | $1,125.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.66 / $840.60 / $920.72
| Facility | | $759.66 | $840.60 | $920.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.64 / $840.60 / $1,450.08
| Professional | | $613.64 | $840.60 | $1,450.08 |
- 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
- $1,182.33 / $1,182.33 / $1,241.46
| Professional | | $1,182.33 | $1,182.33 | $1,241.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.52 / $903.52 / $903.52
| Facility | | $903.52 | $903.52 | $903.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.52 / $903.52 / $903.52
| Professional | | $903.52 | $903.52 | $903.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,861.75 / $7,970.79 / $7,970.79
| Facility | | $2,861.75 | $7,970.79 | $7,970.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.23 / $728.53 / $1,426.08
| Professional | | $523.23 | $728.53 | $1,426.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.80 / $728.53 / $1,426.08
| Professional | | $541.80 | $728.53 | $1,426.08 |