- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.41 / $934.41 / $934.41
| Facility | | $934.41 | $934.41 | $934.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.41 / $934.41 / $1,489.99
| Professional | | $934.41 | $934.41 | $1,489.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.70 / $3,528.38 / $11,657.40
| Facility | | $1,118.70 | $3,528.38 | $11,657.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.82 / $1,456.38 / $2,088.46
| Professional | | $928.82 | $1,456.38 | $2,088.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.88 / $2,761.57 / $3,556.38
| Facility | | $2,269.88 | $2,761.57 | $3,556.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,540.42 / $1,897.51 / $1,897.51
| Professional | | $1,540.42 | $1,897.51 | $1,897.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,237.01 / $1,408.48 / $1,499.28
| Facility | | $1,237.01 | $1,408.48 | $1,499.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.19 / $1,408.48 / $2,317.13
| Professional | | $1,028.19 | $1,408.48 | $2,317.13 |
- 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
- $1,731.51 / $1,731.51 / $1,818.09
| Professional | | $1,731.51 | $1,731.51 | $1,818.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,169.43 / $1,169.43 / $1,169.43
| Professional | | $1,169.43 | $1,169.43 | $1,169.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,491.67 / $11,657.40 / $11,657.40
| Facility | | $4,491.67 | $11,657.40 | $11,657.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.38 / $1,143.17 / $2,088.46
| Professional | | $835.38 | $1,143.17 | $2,088.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.95 / $1,143.17 / $2,088.46
| Professional | | $883.95 | $1,143.17 | $2,088.46 |