- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.54 / $748.54 / $748.54
| Facility | | $748.54 | $748.54 | $748.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.54 / $748.54 / $1,235.16
| Professional | | $748.54 | $748.54 | $1,235.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.83 / $4,880.35 / $8,041.61
| Facility | | $1,532.83 | $4,880.35 | $8,041.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.73 / $1,115.80 / $1,939.03
| Professional | | $740.73 | $1,115.80 | $1,939.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,818.40 / $2,212.29 / $2,849.01
| Facility | | $1,818.40 | $2,212.29 | $2,849.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,234.00 / $1,440.09 / $1,440.09
| Professional | | $1,234.00 | $1,440.09 | $1,440.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.95 / $1,232.20 / $1,232.20
| Facility | | $990.95 | $1,232.20 | $1,232.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.51 / $1,232.20 / $2,103.00
| Professional | | $899.51 | $1,232.20 | $2,103.00 |
- 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
- $1,387.11 / $1,387.11 / $1,456.47
| Professional | | $1,387.11 | $1,387.11 | $1,456.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.76 / $1,232.76 / $1,232.76
| Professional | | $1,232.76 | $1,232.76 | $1,232.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,682.28 / $8,041.61 / $8,041.61
| Facility | | $3,682.28 | $8,041.61 | $8,041.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.23 / $915.77 / $1,673.07
| Professional | | $669.23 | $915.77 | $1,673.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.73 / $915.77 / $1,640.08
| Professional | | $740.73 | $915.77 | $1,640.08 |