- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $765.09 / $765.09 / $765.09
| Facility | | $765.09 | $765.09 | $765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.09 / $765.09 / $1,195.02
| Professional | | $765.09 | $765.09 | $1,195.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.83 / $3,373.23 / $8,140.74
| Facility | | $1,066.83 | $3,373.23 | $8,140.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.89 / $1,140.19 / $1,710.03
| Professional | | $752.89 | $1,140.19 | $1,710.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,911.98 / $2,261.17 / $2,911.97
| Facility | | $1,911.98 | $2,261.17 | $2,911.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,146.61 / $1,610.22 / $1,610.22
| Professional | | $1,146.61 | $1,610.22 | $1,610.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.23 / $926.75 / $1,287.02
| Facility | | $830.23 | $926.75 | $1,287.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.74 / $787.74 / $1,926.38
| Professional | | $787.74 | $787.74 | $1,926.38 |
- 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
- $1,417.77 / $1,417.77 / $1,488.66
| Professional | | $1,417.77 | $1,417.77 | $1,488.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,373.23 / $8,140.74 / $8,140.74
| Facility | | $3,373.23 | $8,140.74 | $8,140.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.01 / $936.02 / $1,710.03
| Professional | | $684.01 | $936.02 | $1,710.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.92 / $936.02 / $1,710.03
| Professional | | $739.92 | $936.02 | $1,710.03 |