- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.36 / $938.36 / $938.36
| Facility | | $938.36 | $938.36 | $938.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.13 / $938.36 / $1,209.26
| Professional | | $865.13 | $938.36 | $1,209.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,687.50 / $3,269.76 / $8,733.07
| Facility | | $1,687.50 | $3,269.76 | $8,733.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.81 / $1,629.87 / $2,097.30
| Professional | | $786.81 | $1,629.87 | $2,097.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,279.48 / $2,773.26 / $3,571.44
| Facility | | $2,279.48 | $2,773.26 | $3,571.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.92 / $1,964.69 / $1,964.69
| Professional | | $1,546.92 | $1,964.69 | $1,964.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.48 / $1,242.23 / $1,505.60
| Facility | | $1,006.48 | $1,242.23 | $1,505.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.73 / $734.73 / $1,867.50
| Professional | | $734.73 | $734.73 | $1,867.50 |
- 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
- $1,738.84 / $1,738.84 / $1,825.78
| Professional | | $1,738.84 | $1,738.84 | $1,825.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.34 / $1,023.34 / $1,023.34
| Professional | | $1,023.34 | $1,023.34 | $1,023.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,269.76 / $8,733.07 / $8,733.07
| Facility | | $3,269.76 | $8,733.07 | $8,733.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.29 / $1,071.43 / $2,097.30
| Professional | | $714.29 | $1,071.43 | $2,097.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.00 / $820.00 / $820.00
| Facility | | $820.00 | $820.00 | $820.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.28 / $1,071.43 / $2,097.30
| Professional | | $726.28 | $1,071.43 | $2,097.30 |