- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.69 / $840.69 / $840.69
| Facility | | $840.69 | $840.69 | $840.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.69 / $880.81 / $1,424.09
| Professional | | $840.69 | $880.81 | $1,424.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.33 / $3,724.66 / $11,345.23
| Facility | | $1,146.33 | $3,724.66 | $11,345.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.46 / $1,377.14 / $1,879.02
| Professional | | $811.46 | $1,377.14 | $1,879.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,042.24 / $2,484.62 / $3,199.72
| Facility | | $2,042.24 | $2,484.62 | $3,199.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,385.92 / $1,385.92 / $1,764.17
| Professional | | $1,385.92 | $1,385.92 | $1,764.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $1,186.93 / $1,348.91
| Facility | | $900.00 | $1,186.93 | $1,348.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $866.46 / $1,186.93 / $2,127.00
| Professional | | $866.46 | $1,186.93 | $2,127.00 |
- 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
- $1,557.87 / $1,557.87 / $1,635.76
| Professional | | $1,557.87 | $1,557.87 | $1,635.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.52 / $1,475.52 / $1,475.52
| Professional | | $1,475.52 | $1,475.52 | $1,475.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,724.66 / $11,345.23 / $11,345.23
| Facility | | $3,724.66 | $11,345.23 | $11,345.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.56 / $959.92 / $1,879.02
| Professional | | $732.56 | $959.92 | $1,879.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,193.78 / $1,193.78 / $1,193.78
| Facility | | $1,193.78 | $1,193.78 | $1,193.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.61 / $1,028.51 / $1,842.00
| Professional | | $751.61 | $1,028.51 | $1,842.00 |