- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,238.72 / $6,918.31
| Facility | | $912.01 | $2,238.72 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,174.90 / $1,621.81
| Professional | | $912.01 | $1,174.90 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Professional | | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,513.56 / $6,918.31
| Facility | | $1,000.00 | $1,513.56 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,238.72
| Professional | | $1,862.09 | $1,862.09 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $11,481.54 / $11,481.54
| Professional | | $7,585.78 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,548.82 / $2,884.03
| Facility | | $1,174.90 | $1,548.82 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $1,862.09
| Professional | | $912.01 | $1,230.27 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,659.59 / $3,311.31
| Professional | | $1,548.82 | $1,659.59 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,548.82 / $4,265.80
| Facility | | $1,071.52 | $1,548.82 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,621.81 / $2,691.53
| Professional | | $79.43 | $1,621.81 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $645.65 / $1,548.82
| Facility | | $549.54 | $645.65 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $1,047.13
| Professional | | $645.65 | $645.65 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,548.82 / $1,548.82
| Professional | | $501.19 | $1,548.82 | $1,548.82 |