- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.66 / $626.66 / $626.66
| Facility | | $626.66 | $626.66 | $626.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.66 / $697.09 / $1,121.04
| Professional | | $626.66 | $697.09 | $1,121.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.89 / $2,526.98 / $8,295.73
| Facility | | $800.89 | $2,526.98 | $8,295.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.21 / $1,089.02 / $1,400.63
| Professional | | $643.21 | $1,089.02 | $1,400.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.30 / $1,852.05 / $2,385.09
| Facility | | $1,522.30 | $1,852.05 | $2,385.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.08 / $1,105.68 / $1,105.68
| Professional | | $1,033.08 | $1,105.68 | $1,105.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.59 / $891.35 / $1,005.48
| Facility | | $829.59 | $891.35 | $1,005.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.69 / $891.35 / $1,827.08
| Professional | | $650.69 | $891.35 | $1,827.08 |
- 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
- $1,161.24 / $1,161.24 / $1,219.30
| Professional | | $1,161.24 | $1,161.24 | $1,219.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.19 / $1,094.19 / $1,094.19
| Professional | | $1,094.19 | $1,094.19 | $1,094.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,605.93 / $8,295.73 / $8,295.73
| Facility | | $3,605.93 | $8,295.73 | $8,295.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.32 / $766.66 / $1,400.63
| Professional | | $548.32 | $766.66 | $1,400.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.82 / $766.66 / $1,400.63
| Professional | | $592.82 | $766.66 | $1,400.63 |