- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.00 / $934.00 / $934.00
| Facility | | $934.00 | $934.00 | $934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.00 / $985.07 / $1,700.96
| Professional | | $934.00 | $985.07 | $1,700.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.77 / $4,445.84 / $10,198.75
| Facility | | $1,412.77 | $4,445.84 | $10,198.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.08 / $1,548.06 / $2,087.56
| Professional | | $976.08 | $1,548.06 | $2,087.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,334.09 / $2,760.40 / $3,554.87
| Facility | | $2,334.09 | $2,760.40 | $3,554.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,539.71 / $1,896.70 / $1,896.70
| Professional | | $1,539.71 | $1,896.70 | $1,896.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.54 / $1,222.54 / $1,571.14
| Facility | | $1,222.54 | $1,222.54 | $1,571.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.45 / $892.45 / $2,539.13
| Professional | | $892.45 | $892.45 | $2,539.13 |
- 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
- $1,730.77 / $1,730.77 / $1,817.31
| Professional | | $1,730.77 | $1,730.77 | $1,817.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,652.47 / $1,652.47 / $1,652.47
| Professional | | $1,652.47 | $1,652.47 | $1,652.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,445.84 / $10,198.75 / $10,198.75
| Facility | | $4,445.84 | $10,198.75 | $10,198.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.02 / $1,142.65 / $2,087.56
| Professional | | $835.02 | $1,142.65 | $2,087.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,608.67 / $2,608.67 / $2,608.67
| Facility | | $2,608.67 | $2,608.67 | $2,608.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.40 / $1,142.65 / $2,087.56
| Professional | | $928.40 | $1,142.65 | $2,087.56 |