- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.66 / $874.66 / $874.66
| Facility | | $874.66 | $874.66 | $874.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $874.66 / $942.72 / $1,272.90
| Professional | | $874.66 | $942.72 | $1,272.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.70 / $3,706.25 / $11,918.65
| Facility | | $1,118.70 | $3,706.25 | $11,918.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.48 / $1,446.75 / $1,954.94
| Professional | | $852.48 | $1,446.75 | $1,954.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,124.76 / $2,585.02 / $3,329.01
| Facility | | $2,124.76 | $2,585.02 | $3,329.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.90 / $1,821.05 / $1,821.05
| Professional | | $1,441.90 | $1,821.05 | $1,821.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.90 / $1,277.46 / $1,403.39
| Facility | | $1,157.90 | $1,277.46 | $1,403.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.55 / $1,277.46 / $2,407.50
| Professional | | $932.55 | $1,277.46 | $2,407.50 |
- 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
- $1,620.81 / $1,620.81 / $1,701.85
| Professional | | $1,620.81 | $1,620.81 | $1,701.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,331.96 / $1,331.96 / $1,331.96
| Facility | | $1,331.96 | $1,331.96 | $1,331.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.96 / $1,331.96 / $1,331.96
| Professional | | $1,331.96 | $1,331.96 | $1,331.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,215.38 / $11,918.65 / $11,918.65
| Facility | | $4,215.38 | $11,918.65 | $11,918.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.16 / $1,012.73 / $1,954.94
| Professional | | $762.16 | $1,012.73 | $1,954.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.98 / $1,012.73 / $1,954.94
| Professional | | $781.98 | $1,012.73 | $1,954.94 |