- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.10 / $843.32 / $859.54
| Facility | | $827.10 | $843.32 | $859.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.51 / $859.54 / $1,213.47
| Professional | | $782.51 | $859.54 | $1,213.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.43 / $881.43 / $1,102.80
| Professional | | $881.43 | $881.43 | $1,102.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.10 / $1,852.10 / $1,852.10
| Facility | | $1,852.10 | $1,852.10 | $1,852.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.38 / $1,028.38 / $1,028.38
| Facility | | $1,028.38 | $1,028.38 | $1,028.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.72 / $750.72 / $750.72
| Professional | | $750.72 | $750.72 | $750.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,095.10 / $8,579.00 / $8,579.00
| Facility | | $3,095.10 | $8,579.00 | $8,579.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,275.29 / $9,275.29 / $13,485.98
| Professional | | $9,275.29 | $9,275.29 | $13,485.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.05 / $1,390.49 / $1,852.10
| Facility | | $530.05 | $1,390.49 | $1,852.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.05 / $1,666.89 / $1,852.10
| Professional | | $530.05 | $1,666.89 | $1,852.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,416.86 / $1,852.10 / $4,167.22
| Professional | | $1,416.86 | $1,852.10 | $4,167.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.05 / $1,113.50 / $1,852.10
| Facility | | $530.05 | $1,113.50 | $1,852.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.72 / $750.72 / $1,495.12
| Professional | | $750.72 | $750.72 | $1,495.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.22 / $989.45 / $1,177.92
| Professional | | $684.22 | $989.45 | $1,177.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.99 / $1,002.36 / $1,852.10
| Professional | | $985.99 | $1,002.36 | $1,852.10 |