- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.84 / $706.84 / $706.84
| Facility | | $706.84 | $706.84 | $706.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.84 / $713.22 / $910.90
| Professional | | $706.84 | $713.22 | $910.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $915.30 / $3,032.39 / $7,331.10
| Facility | | $915.30 | $3,032.39 | $7,331.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.92 / $1,067.41 / $1,579.83
| Professional | | $631.92 | $1,067.41 | $1,579.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,717.07 / $2,089.01 / $2,690.26
| Facility | | $1,717.07 | $2,089.01 | $2,690.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.32 / $1,247.15 / $1,247.15
| Professional | | $1,059.32 | $1,247.15 | $1,247.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.96 / $935.73 / $1,134.13
| Facility | | $842.96 | $935.73 | $1,134.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.36 / $842.96 / $1,783.50
| Professional | | $615.36 | $842.96 | $1,783.50 |
- 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
- $1,309.82 / $1,309.82 / $1,375.31
| Professional | | $1,309.82 | $1,309.82 | $1,375.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.92 / $973.92 / $973.92
| Professional | | $973.92 | $973.92 | $973.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,123.09 / $7,331.10 / $7,331.10
| Facility | | $3,123.09 | $7,331.10 | $7,331.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.86 / $807.08 / $1,579.83
| Professional | | $560.86 | $807.08 | $1,579.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.41 / $807.08 / $1,579.83
| Professional | | $570.41 | $807.08 | $1,579.83 |