- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.41 / $775.41 / $775.41
| Facility | | $775.41 | $775.41 | $775.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.41 / $793.91 / $1,491.83
| Professional | | $775.41 | $793.91 | $1,491.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.89 / $2,405.71 / $11,239.74
| Facility | | $800.89 | $2,405.71 | $11,239.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.21 / $1,364.34 / $1,733.10
| Professional | | $800.21 | $1,364.34 | $1,733.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,883.65 / $2,291.67 / $2,951.24
| Facility | | $1,883.65 | $2,291.67 | $2,951.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.08 / $1,574.64 / $1,574.64
| Professional | | $1,162.08 | $1,574.64 | $1,574.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.52 / $1,304.38 / $1,530.70
| Facility | | $1,026.52 | $1,304.38 | $1,530.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.41 / $1,117.41 / $2,743.13
| Professional | | $1,117.41 | $1,117.41 | $2,743.13 |
- 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
- $1,436.90 / $1,436.90 / $1,508.74
| Professional | | $1,436.90 | $1,436.90 | $1,508.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.53 / $1,127.53 / $1,127.53
| Professional | | $1,127.53 | $1,127.53 | $1,127.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,803.51 / $11,239.74 / $11,239.74
| Facility | | $4,803.51 | $11,239.74 | $11,239.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.53 / $948.64 / $1,733.10
| Professional | | $733.53 | $948.64 | $1,733.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.53 / $948.64 / $1,733.10
| Professional | | $733.53 | $948.64 | $1,733.10 |