- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.71 / $839.71 / $839.71
| Facility | | $839.71 | $839.71 | $839.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.25 / $839.71 / $1,124.99
| Professional | | $838.25 | $839.71 | $1,124.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $3,207.62 / $7,687.40
| Facility | | $1,017.00 | $3,207.62 | $7,687.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.17 / $1,169.86 / $1,876.81
| Professional | | $778.17 | $1,169.86 | $1,876.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,039.86 / $2,481.71 / $3,195.99
| Facility | | $2,039.86 | $2,481.71 | $3,195.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,384.30 / $1,705.23 / $1,705.23
| Professional | | $1,384.30 | $1,705.23 | $1,705.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.65 / $1,200.11 / $1,347.32
| Facility | | $1,110.65 | $1,200.11 | $1,347.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.09 / $1,200.11 / $1,990.13
| Professional | | $876.09 | $1,200.11 | $1,990.13 |
- 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
- $1,556.04 / $1,556.04 / $1,633.84
| Professional | | $1,556.04 | $1,556.04 | $1,633.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.76 / $915.76 / $915.76
| Professional | | $915.76 | $915.76 | $915.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,484.96 / $7,687.40 / $7,687.40
| Facility | | $3,484.96 | $7,687.40 | $7,687.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.09 / $1,027.30 / $1,876.81
| Professional | | $719.09 | $1,027.30 | $1,876.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.70 / $1,027.30 / $1,556.04
| Professional | | $731.70 | $1,027.30 | $1,556.04 |