- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.14 / $904.14 / $904.14
| Facility | | $904.14 | $904.14 | $904.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.14 / $1,387.47 / $3,398.45
| Professional | | $904.14 | $1,387.47 | $3,398.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,414.00 / $6,551.58
| Facility | | $789.00 | $3,414.00 | $6,551.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.08 / $2,103.54 / $8,092.80
| Professional | | $1,180.08 | $2,103.54 | $8,092.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.50 / $2,152.66 / $3,711.17
| Professional | | $1,563.50 | $2,152.66 | $3,711.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.91 / $2,247.13 / $4,143.56
| Professional | | $1,245.91 | $2,247.13 | $4,143.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,795.26 / $8,090.00
| Facility | | $300.00 | $1,795.26 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.38 / $1,289.15 / $2,061.21
| Professional | | $692.38 | $1,289.15 | $2,061.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,439.33 / $2,853.33 / $3,622.79
| Professional | | $1,439.33 | $2,853.33 | $3,622.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,496.23 / $1,496.23 / $1,888.61
| Professional | | $1,496.23 | $1,496.23 | $1,888.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $7,231.00
| Facility | | $55.00 | $2,854.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.76 / $2,224.67 / $8,092.80
| Professional | | $1,266.76 | $2,224.67 | $8,092.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $2,446.00 / $4,662.00
| Facility | | $953.00 | $2,446.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.76 / $1,667.56 / $3,153.95
| Professional | | $1,266.76 | $1,667.56 | $3,153.95 |