- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.51 / $880.51 / $880.51
| Facility | | $880.51 | $880.51 | $880.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.51 / $970.54 / $1,290.68
| Professional | | $880.51 | $970.54 | $1,290.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,803.04 / $5,740.66 / $9,614.69
| Facility | | $1,803.04 | $5,740.66 | $9,614.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.51 / $1,497.00 / $1,968.00
| Professional | | $835.51 | $1,497.00 | $1,968.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.40 / $2,602.29 / $3,351.25
| Facility | | $2,200.40 | $2,602.29 | $3,351.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.58 / $1,553.57 / $1,553.57
| Professional | | $1,319.58 | $1,553.57 | $1,553.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.63 / $1,335.63 / $1,335.63
| Facility | | $1,335.63 | $1,335.63 | $1,335.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.01 / $1,335.63 / $2,393.63
| Professional | | $975.01 | $1,335.63 | $2,393.63 |
- 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
- $1,631.65 / $1,631.65 / $1,713.23
| Professional | | $1,631.65 | $1,631.65 | $1,713.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,534.44 / $1,534.44 / $1,534.44
| Professional | | $1,534.44 | $1,534.44 | $1,534.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,191.35 / $9,614.69 / $9,614.69
| Facility | | $4,191.35 | $9,614.69 | $9,614.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.82 / $1,005.38 / $1,968.00
| Professional | | $766.82 | $1,005.38 | $1,968.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.88 / $1,077.21 / $1,968.00
| Professional | | $779.88 | $1,077.21 | $1,968.00 |