- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.86 / $801.86 / $801.86
| Facility | | $801.86 | $801.86 | $801.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.86 / $891.98 / $1,409.24
| Professional | | $801.86 | $891.98 | $1,409.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $3,207.62 / $9,399.59
| Facility | | $1,017.00 | $3,207.62 | $9,399.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.60 / $1,366.23 / $1,792.21
| Professional | | $886.60 | $1,366.23 | $1,792.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,947.89 / $2,369.84 / $3,051.90
| Facility | | $1,947.89 | $2,369.84 | $3,051.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.72 / $1,628.35 / $1,628.35
| Professional | | $1,201.72 | $1,628.35 | $1,628.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.52 / $1,316.65 / $1,316.65
| Facility | | $1,061.52 | $1,316.65 | $1,316.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.15 / $1,316.65 / $2,359.50
| Professional | | $961.15 | $1,316.65 | $2,359.50 |
- 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
- $1,485.89 / $1,485.89 / $1,560.18
| Professional | | $1,485.89 | $1,485.89 | $1,560.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.30 / $1,401.30 / $1,401.30
| Professional | | $1,401.30 | $1,401.30 | $1,401.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,131.74 / $9,399.59 / $9,399.59
| Facility | | $4,131.74 | $9,399.59 | $9,399.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.84 / $980.99 / $1,792.21
| Professional | | $738.84 | $980.99 | $1,792.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.06 / $980.99 / $1,792.21
| Professional | | $797.06 | $980.99 | $1,792.21 |