- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.31 / $804.31 / $804.31
| Facility | | $804.31 | $804.31 | $804.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.31 / $848.27 / $1,464.77
| Professional | | $804.31 | $848.27 | $1,464.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.76 / $4,288.72 / $8,782.71
| Facility | | $1,436.76 | $4,288.72 | $8,782.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.55 / $1,383.40 / $1,797.71
| Professional | | $840.55 | $1,383.40 | $1,797.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,010.00 / $2,377.11 / $3,061.27
| Facility | | $2,010.00 | $2,377.11 | $3,061.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,491.30 / $1,633.34 / $1,633.34
| Professional | | $1,491.30 | $1,633.34 | $1,633.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.56 / $1,329.56 / $1,329.56
| Facility | | $1,329.56 | $1,329.56 | $1,329.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.58 / $970.58 / $2,186.63
| Professional | | $970.58 | $970.58 | $2,186.63 |
- 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
- $1,490.45 / $1,490.45 / $1,564.97
| Professional | | $1,490.45 | $1,490.45 | $1,564.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.68 / $1,187.68 / $1,187.68
| Professional | | $1,187.68 | $1,187.68 | $1,187.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,828.62 / $8,782.71 / $8,782.71
| Facility | | $3,828.62 | $8,782.71 | $8,782.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.08 / $1,106.72 / $1,797.71
| Professional | | $719.08 | $1,106.72 | $1,797.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.08 / $1,106.72 / $1,797.71
| Professional | | $719.08 | $1,106.72 | $1,797.71 |