- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.01 / $731.01 / $731.01
| Facility | | $731.01 | $731.01 | $731.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.45 / $731.01 / $942.05
| Professional | | $682.45 | $731.01 | $942.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $991.58 / $3,285.10 / $8,331.26
| Facility | | $991.58 | $3,285.10 | $8,331.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.58 / $1,041.16 / $1,633.86
| Professional | | $642.58 | $1,041.16 | $1,633.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.79 / $2,160.44 / $2,782.26
| Facility | | $1,775.79 | $2,160.44 | $2,782.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.08 / $1,289.80 / $1,289.80
| Professional | | $1,205.08 | $1,289.80 | $1,289.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.86 / $967.74 / $1,172.92
| Facility | | $830.86 | $967.74 | $1,172.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.53 / $830.86 / $1,539.38
| Professional | | $606.53 | $830.86 | $1,539.38 |
- 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
- $1,354.61 / $1,354.61 / $1,422.34
| Professional | | $1,354.61 | $1,354.61 | $1,422.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.76 / $835.76 / $835.76
| Professional | | $835.76 | $835.76 | $835.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,093.45 / $8,331.26 / $8,331.26
| Facility | | $4,093.45 | $8,331.26 | $8,331.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.45 / $834.68 / $1,633.86
| Professional | | $556.45 | $834.68 | $1,633.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.64 / $876.64 / $876.64
| Facility | | $876.64 | $876.64 | $876.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.15 / $834.68 / $1,429.17
| Professional | | $593.15 | $834.68 | $1,429.17 |