- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.32 / $900.32 / $900.32
| Facility | | $900.32 | $900.32 | $900.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.32 / $943.56 / $1,773.02
| Professional | | $900.32 | $943.56 | $1,773.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.70 / $3,528.38 / $12,990.49
| Facility | | $1,118.70 | $3,528.38 | $12,990.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.14 / $1,576.86 / $2,012.27
| Professional | | $1,006.14 | $1,576.86 | $2,012.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.09 / $2,660.84 / $3,426.66
| Facility | | $2,187.09 | $2,660.84 | $3,426.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,349.29 / $1,828.31 / $1,828.31
| Professional | | $1,349.29 | $1,828.31 | $1,828.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.89 / $1,514.51 / $1,637.27
| Facility | | $1,191.89 | $1,514.51 | $1,637.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.21 / $1,637.27 / $2,934.00
| Professional | | $1,195.21 | $1,637.27 | $2,934.00 |
- 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
- $1,668.35 / $1,668.35 / $1,751.77
| Professional | | $1,668.35 | $1,668.35 | $1,751.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,340.05 / $1,340.05 / $1,340.05
| Professional | | $1,340.05 | $1,340.05 | $1,340.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,137.87 / $12,990.49 / $12,990.49
| Facility | | $5,137.87 | $12,990.49 | $12,990.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.70 / $1,107.34 / $2,012.27
| Professional | | $851.70 | $1,107.34 | $2,012.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.91 / $1,366.91 / $1,366.91
| Facility | | $1,366.91 | $1,366.91 | $1,366.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.94 / $1,148.82 / $2,012.27
| Professional | | $894.94 | $1,148.82 | $2,012.27 |