- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $961.72 / $961.72 / $961.72
| Facility | | $961.72 | $961.72 | $961.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.72 / $961.72 / $1,239.35
| Professional | | $961.72 | $961.72 | $1,239.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $3,831.58 / $10,066.52
| Facility | | $1,175.00 | $3,831.58 | $10,066.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.80 / $1,493.44 / $2,149.51
| Professional | | $859.80 | $1,493.44 | $2,149.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,336.23 / $2,842.30 / $3,660.35
| Facility | | $2,336.23 | $2,842.30 | $3,660.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.29 / $1,696.87 / $1,696.87
| Professional | | $1,441.29 | $1,696.87 | $1,696.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.41 / $1,273.15 / $1,543.08
| Facility | | $1,179.41 | $1,273.15 | $1,543.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.97 / $1,179.40 / $2,188.13
| Professional | | $860.97 | $1,179.40 | $2,188.13 |
- 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
- $1,782.13 / $1,782.13 / $1,871.24
| Professional | | $1,782.13 | $1,782.13 | $1,871.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.15 / $1,444.15 / $1,444.15
| Professional | | $1,444.15 | $1,444.15 | $1,444.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,831.58 / $10,066.52 / $10,066.52
| Facility | | $3,831.58 | $10,066.52 | $10,066.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.70 / $1,098.09 / $2,149.51
| Professional | | $784.70 | $1,098.09 | $2,149.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.07 / $1,098.09 / $2,149.51
| Professional | | $798.07 | $1,098.09 | $2,149.51 |