- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.21 / $903.21 / $1,225.66
| Facility | | $903.21 | $903.21 | $1,225.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.08 / $903.21 / $1,009.47
| Professional | | $850.08 | $903.21 | $1,009.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.70 / $1,660.90 / $2,949.20
| Facility | | $934.70 | $1,660.90 | $2,949.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.50 / $890.19 / $2,227.88
| Professional | | $885.50 | $890.19 | $2,227.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.27 / $1,120.59 / $2,064.10
| Facility | | $654.27 | $1,120.59 | $2,064.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.21 / $903.21 / $903.21
| Facility | | $903.21 | $903.21 | $903.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.21 / $903.21 / $903.21
| Professional | | $903.21 | $903.21 | $903.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.60 / $1,312.31 / $6,679.00
| Facility | | $729.60 | $1,312.31 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.36 / $1,413.26 / $2,045.59
| Professional | | $1,158.36 | $1,413.26 | $2,045.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.21 / $903.21 / $1,456.88
| Professional | | $903.21 | $903.21 | $1,456.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.47 / $1,009.47 / $3,576.45
| Facility | | $1,009.47 | $1,009.47 | $3,576.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.50 / $885.50 / $4,037.88
| Professional | | $885.50 | $885.50 | $4,037.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.50 / $885.50 / $1,328.25
| Professional | | $885.50 | $885.50 | $1,328.25 |