- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $915.51 / $915.51 / $915.51
| Facility | | $915.51 | $915.51 | $915.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.51 / $915.51 / $1,284.29
| Professional | | $915.51 | $915.51 | $1,284.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.00 / $3,538.28 / $11,179.36
| Facility | | $1,068.00 | $3,538.28 | $11,179.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.48 / $1,396.66 / $2,046.21
| Professional | | $818.48 | $1,396.66 | $2,046.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,223.98 / $2,705.72 / $3,484.46
| Facility | | $2,223.98 | $2,705.72 | $3,484.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.24 / $1,921.17 / $1,921.17
| Professional | | $1,509.24 | $1,921.17 | $1,921.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.20 / $1,211.99 / $1,468.94
| Facility | | $1,184.20 | $1,211.99 | $1,468.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.47 / $1,184.20 / $2,499.75
| Professional | | $864.47 | $1,184.20 | $2,499.75 |
- 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
- $1,696.50 / $1,696.50 / $1,781.32
| Professional | | $1,696.50 | $1,696.50 | $1,781.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.92 / $1,243.92 / $1,243.92
| Professional | | $1,243.92 | $1,243.92 | $1,243.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,376.92 / $11,179.36 / $11,179.36
| Facility | | $4,376.92 | $11,179.36 | $11,179.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.85 / $1,045.33 / $2,046.21
| Professional | | $733.85 | $1,045.33 | $2,046.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.60 / $1,047.50 / $1,765.16
| Professional | | $799.60 | $1,047.50 | $1,765.16 |