- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.79 / $696.79 / $696.79
| Facility | | $696.79 | $696.79 | $696.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.79 / $713.42 / $1,340.56
| Professional | | $696.79 | $713.42 | $1,340.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.89 / $2,405.71 / $10,100.12
| Facility | | $800.89 | $2,405.71 | $10,100.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.75 / $1,226.00 / $1,557.38
| Professional | | $762.75 | $1,226.00 | $1,557.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,692.66 / $2,059.32 / $2,652.02
| Facility | | $1,692.66 | $2,059.32 | $2,652.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.69 / $1,414.98 / $1,414.98
| Professional | | $1,148.69 | $1,414.98 | $1,414.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.43 / $1,020.64 / $1,118.01
| Facility | | $922.43 | $1,020.64 | $1,118.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.07 / $1,020.64 / $2,465.25
| Professional | | $745.07 | $1,020.64 | $2,465.25 |
- 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
- $1,291.20 / $1,291.20 / $1,355.76
| Professional | | $1,291.20 | $1,291.20 | $1,355.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.19 / $1,013.19 / $1,013.19
| Professional | | $1,013.19 | $1,013.19 | $1,013.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,316.47 / $10,100.12 / $10,100.12
| Facility | | $4,316.47 | $10,100.12 | $10,100.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.15 / $880.56 / $1,557.38
| Professional | | $659.15 | $880.56 | $1,557.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.90 / $1,210.29 / $1,355.76
| Professional | | $748.90 | $1,210.29 | $1,355.76 |