- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.12 / $792.12 / $792.12
| Facility | | $792.12 | $792.12 | $792.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $792.12 / $881.14 / $1,595.13
| Professional | | $792.12 | $881.14 | $1,595.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.37 / $2,710.45 / $11,437.15
| Facility | | $859.37 | $2,710.45 | $11,437.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.37 / $1,393.73 / $1,770.43
| Professional | | $859.37 | $1,393.73 | $1,770.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.23 / $2,341.05 / $3,014.83
| Facility | | $1,924.23 | $2,341.05 | $3,014.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.10 / $1,608.57 / $1,608.57
| Professional | | $1,187.10 | $1,608.57 | $1,608.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.63 / $1,132.82 / $1,270.95
| Facility | | $1,048.63 | $1,132.82 | $1,270.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.96 / $826.96 / $2,714.25
| Professional | | $826.96 | $826.96 | $2,714.25 |
- 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
- $1,467.84 / $1,467.84 / $1,541.23
| Professional | | $1,467.84 | $1,467.84 | $1,541.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.59 / $1,361.59 / $1,361.59
| Professional | | $1,361.59 | $1,361.59 | $1,361.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,752.55 / $11,437.15 / $11,437.15
| Facility | | $4,752.55 | $11,437.15 | $11,437.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.33 / $969.07 / $1,770.43
| Professional | | $749.33 | $969.07 | $1,770.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.80 / $1,052.80 / $1,052.80
| Facility | | $1,052.80 | $1,052.80 | $1,052.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.37 / $969.07 / $1,770.43
| Professional | | $787.37 | $969.07 | $1,770.43 |