- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.75 / $752.75 / $752.75
| Facility | | $752.75 | $752.75 | $752.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.75 / $810.02 / $1,339.69
| Professional | | $752.75 | $810.02 | $1,339.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $915.30 / $2,886.86 / $8,810.16
| Facility | | $915.30 | $2,886.86 | $8,810.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.12 / $1,269.94 / $1,682.47
| Professional | | $824.12 | $1,269.94 | $1,682.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.61 / $2,224.71 / $2,865.02
| Facility | | $1,828.61 | $2,224.71 | $2,865.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.11 / $1,528.63 / $1,528.63
| Professional | | $1,128.11 | $1,528.63 | $1,528.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.64 / $1,266.25 / $1,324.18
| Facility | | $995.64 | $1,266.25 | $1,324.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.65 / $1,324.18 / $2,373.00
| Professional | | $966.65 | $1,324.18 | $2,373.00 |
- 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
- $1,394.90 / $1,394.90 / $1,464.64
| Professional | | $1,394.90 | $1,394.90 | $1,464.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.08 / $1,154.08 / $1,154.08
| Professional | | $1,154.08 | $1,154.08 | $1,154.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,155.41 / $8,810.16 / $8,810.16
| Facility | | $4,155.41 | $8,810.16 | $8,810.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.77 / $920.91 / $1,682.47
| Professional | | $686.77 | $920.91 | $1,682.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $640.00
| Facility | | $640.00 | $640.00 | $640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.09 / $960.51 / $1,661.84
| Professional | | $712.09 | $960.51 | $1,661.84 |