- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.19 / $832.19 / $832.19
| Facility | | $832.19 | $832.19 | $832.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.19 / $925.72 / $1,601.06
| Professional | | $832.19 | $925.72 | $1,601.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.09 / $5,086.71 / $9,894.54
| Facility | | $1,704.09 | $5,086.71 | $9,894.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.00 / $1,464.24 / $1,860.00
| Professional | | $930.00 | $1,464.24 | $1,860.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,079.65 / $2,459.48 / $3,167.35
| Facility | | $2,079.65 | $2,459.48 | $3,167.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.90 / $1,689.94 / $1,689.94
| Professional | | $1,371.90 | $1,689.94 | $1,689.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,551.30 / $1,551.30 / $1,551.30
| Facility | | $1,551.30 | $1,551.30 | $1,551.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.45 / $1,551.30 / $2,780.25
| Professional | | $1,132.45 | $1,551.30 | $2,780.25 |
- 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
- $1,542.10 / $1,542.10 / $1,619.20
| Professional | | $1,542.10 | $1,542.10 | $1,619.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.66 / $1,404.66 / $1,404.66
| Professional | | $1,404.66 | $1,404.66 | $1,404.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,868.16 / $9,894.54 / $9,894.54
| Facility | | $4,868.16 | $9,894.54 | $9,894.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.24 / $1,061.88 / $1,860.00
| Professional | | $787.24 | $1,061.88 | $1,860.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.21 / $1,018.10 / $2,144.88
| Professional | | $827.21 | $1,018.10 | $2,144.88 |