- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.07 / $774.07 / $774.07
| Facility | | $774.07 | $774.07 | $774.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.07 / $853.48 / $1,299.03
| Professional | | $774.07 | $853.48 | $1,299.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,611.23 / $10,211.21
| Facility | | $818.35 | $2,611.23 | $10,211.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.18 / $1,349.00 / $1,730.10
| Professional | | $788.18 | $1,349.00 | $1,730.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,880.39 / $2,287.71 / $2,946.14
| Facility | | $1,880.39 | $2,287.71 | $2,946.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.08 / $1,365.77 / $1,365.77
| Professional | | $1,160.08 | $1,365.77 | $1,365.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.74 / $1,107.01 / $1,242.00
| Facility | | $1,024.74 | $1,107.01 | $1,242.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.12 / $1,107.01 / $2,394.73
| Professional | | $808.12 | $1,107.01 | $2,394.73 |
- 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
- $1,434.41 / $1,434.41 / $1,506.13
| Professional | | $1,434.41 | $1,434.41 | $1,506.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.86 / $1,226.86 / $1,226.86
| Professional | | $1,226.86 | $1,226.86 | $1,226.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,725.78 / $10,211.21 / $10,211.21
| Facility | | $4,725.78 | $10,211.21 | $10,211.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.99 / $899.34 / $1,730.10
| Professional | | $680.99 | $899.34 | $1,730.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.04 / $947.00 / $1,730.10
| Professional | | $692.04 | $947.00 | $1,730.10 |