- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.75 / $922.75 / $922.75
| Facility | | $922.75 | $922.75 | $922.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.75 / $973.23 / $1,680.51
| Professional | | $922.75 | $973.23 | $1,680.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,889.54 / $5,640.28 / $10,094.70
| Facility | | $1,889.54 | $5,640.28 | $10,094.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.33 / $1,568.84 / $2,062.41
| Professional | | $964.33 | $1,568.84 | $2,062.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.62 / $2,754.97 / $3,513.77
| Facility | | $2,368.62 | $2,754.97 | $3,513.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.18 / $1,775.24 / $1,775.24
| Professional | | $1,521.18 | $1,775.24 | $1,775.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.83 / $1,220.48 / $1,480.56
| Facility | | $1,207.83 | $1,220.48 | $1,480.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.72 / $1,207.83 / $2,508.38
| Professional | | $881.72 | $1,207.83 | $2,508.38 |
- 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
- $1,709.92 / $1,709.92 / $1,795.42
| Professional | | $1,709.92 | $1,709.92 | $1,795.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,541.77 / $1,541.77 / $1,541.77
| Professional | | $1,541.77 | $1,541.77 | $1,541.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,392.45 / $10,094.70 / $10,094.70
| Facility | | $4,392.45 | $10,094.70 | $10,094.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.96 / $1,128.89 / $2,062.41
| Professional | | $824.96 | $1,128.89 | $2,062.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.55 / $1,055.55 / $1,055.55
| Facility | | $1,055.55 | $1,055.55 | $1,055.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.96 / $1,132.59 / $2,062.41
| Professional | | $824.96 | $1,132.59 | $2,062.41 |