- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $855.41 / $855.41 / $855.41
| Facility | | $855.41 | $855.41 | $855.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.41 / $855.41 / $1,221.49
| Professional | | $855.41 | $855.41 | $1,221.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.64 / $5,577.01 / $9,872.78
| Facility | | $1,751.64 | $5,577.01 | $9,872.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.38 / $1,417.93 / $1,911.90
| Professional | | $791.38 | $1,417.93 | $1,911.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.67 / $2,528.10 / $3,255.72
| Facility | | $2,137.67 | $2,528.10 | $3,255.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,410.18 / $1,410.18 / $1,795.04
| Professional | | $1,410.18 | $1,410.18 | $1,795.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.41 / $1,108.41 / $1,438.95
| Facility | | $1,108.41 | $1,108.41 | $1,438.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.14 / $1,108.41 / $2,356.50
| Professional | | $809.14 | $1,108.41 | $2,356.50 |
- 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
- $1,585.13 / $1,585.13 / $1,664.39
| Professional | | $1,585.13 | $1,585.13 | $1,664.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.46 / $1,448.46 / $1,448.46
| Professional | | $1,448.46 | $1,448.46 | $1,448.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,126.64 / $9,872.78 / $9,872.78
| Facility | | $4,126.64 | $9,872.78 | $9,872.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.31 / $976.72 / $1,911.90
| Professional | | $726.31 | $976.72 | $1,911.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.76 / $1,036.73 / $1,911.90
| Professional | | $764.76 | $1,036.73 | $1,911.90 |