- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.34 / $956.34 / $956.34
| Facility | | $956.34 | $956.34 | $956.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.34 / $956.34 / $1,468.88
| Professional | | $956.34 | $956.34 | $1,468.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.64 / $3,704.81 / $10,029.48
| Facility | | $1,174.64 | $3,704.81 | $10,029.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.68 / $1,418.23 / $2,137.46
| Professional | | $904.68 | $1,418.23 | $2,137.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,323.15 / $2,826.38 / $3,639.85
| Facility | | $2,323.15 | $2,826.38 | $3,639.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,433.23 / $1,942.05 / $1,942.05
| Professional | | $1,433.23 | $1,942.05 | $1,942.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.04 / $1,375.24 / $1,534.46
| Facility | | $1,266.04 | $1,375.24 | $1,534.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.93 / $1,375.24 / $2,464.50
| Professional | | $1,003.93 | $1,375.24 | $2,464.50 |
- 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
- $1,772.14 / $1,772.14 / $1,860.75
| Professional | | $1,772.14 | $1,772.14 | $1,860.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.18 / $1,110.18 / $1,110.18
| Professional | | $1,110.18 | $1,110.18 | $1,110.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,315.58 / $10,029.48 / $10,029.48
| Facility | | $4,315.58 | $10,029.48 | $10,029.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.99 / $1,169.98 / $2,137.46
| Professional | | $854.99 | $1,169.98 | $2,137.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.76 / $1,169.98 / $1,945.59
| Professional | | $871.76 | $1,169.98 | $1,945.59 |