- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.27 / $637.27 / $637.27
| Facility | | $637.27 | $637.27 | $637.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.27 / $672.14 / $1,160.63
| Professional | | $637.27 | $672.14 | $1,160.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,138.36 / $3,398.03 / $6,958.79
| Facility | | $1,138.36 | $3,398.03 | $6,958.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.00 / $1,096.09 / $1,424.34
| Professional | | $666.00 | $1,096.09 | $1,424.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,592.54 / $1,883.41 / $2,425.46
| Facility | | $1,592.54 | $1,883.41 | $2,425.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,074.18 / $1,294.10 / $1,294.10
| Professional | | $1,074.18 | $1,294.10 | $1,294.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.10 / $967.10 / $967.10
| Facility | | $967.10 | $967.10 | $967.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.98 / $967.10 / $1,732.50
| Professional | | $705.98 | $967.10 | $1,732.50 |
- 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
- $1,180.90 / $1,180.90 / $1,239.94
| Professional | | $1,180.90 | $1,180.90 | $1,239.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.28 / $941.28 / $941.28
| Professional | | $941.28 | $941.28 | $941.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,033.61 / $6,958.79 / $6,958.79
| Facility | | $3,033.61 | $6,958.79 | $6,958.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.74 / $876.88 / $1,424.34
| Professional | | $569.74 | $876.88 | $1,424.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.74 / $876.88 / $1,424.34
| Professional | | $569.74 | $876.88 | $1,424.34 |