- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.83 / $842.83 / $842.83
| Facility | | $842.83 | $842.83 | $842.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $842.83 / $903.07 / $1,086.14
| Professional | | $842.83 | $903.07 | $1,086.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.88 / $5,151.75 / $10,513.18
| Facility | | $1,725.88 | $5,151.75 | $10,513.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.06 / $1,463.94 / $1,883.78
| Professional | | $810.06 | $1,463.94 | $1,883.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,036.29 / $2,489.33 / $3,193.53
| Facility | | $2,036.29 | $2,489.33 | $3,193.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.23 / $1,487.09 / $1,487.09
| Professional | | $1,419.23 | $1,487.09 | $1,487.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.25 / $1,037.25 / $1,037.25
| Facility | | $1,037.25 | $1,037.25 | $1,037.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.19 / $1,037.25 / $2,059.13
| Professional | | $757.19 | $1,037.25 | $2,059.13 |
- 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
- $1,573.00 / $1,573.00 / $1,651.65
| Professional | | $1,573.00 | $1,573.00 | $1,651.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.25 / $1,371.71 / $1,371.71
| Professional | | $1,252.25 | $1,371.71 | $1,371.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,605.58 / $10,513.18 / $10,513.18
| Facility | | $3,605.58 | $10,513.18 | $10,513.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.57 / $962.35 / $1,883.78
| Professional | | $641.57 | $962.35 | $1,883.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.88 / $985.07 / $1,883.78
| Professional | | $701.88 | $985.07 | $1,883.78 |