- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.02 / $1,770.02 / $1,770.02
| Facility | | $1,770.02 | $1,770.02 | $1,770.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,770.02 / $1,770.02 / $2,522.01
| Professional | | $1,770.02 | $1,770.02 | $2,522.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,546.45 / $8,991.18 / $20,312.33
| Facility | | $1,546.45 | $8,991.18 | $20,312.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.50 / $474.37 / $474.37
| Professional | | $379.50 | $474.37 | $474.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,742.79 / $6,725.86 / $16,179.97
| Facility | | $4,742.79 | $6,725.86 | $16,179.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,874.86 / $6,306.34 / $9,145.75
| Professional | | $3,874.86 | $6,306.34 | $9,145.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,855.55 / $6,149.05 / $12,740.14
| Facility | | $3,855.55 | $6,149.05 | $12,740.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,238.17 / $5,197.26 / $7,736.61
| Professional | | $3,238.17 | $5,197.26 | $7,736.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,605.57 / $3,455.00 / $5,900.22
| Facility | | $2,605.57 | $3,455.00 | $5,900.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,082.94 / $3,682.45 / $7,488.18
| Professional | | $2,082.94 | $3,682.45 | $7,488.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,082.94 / $3,354.81 / $7,150.00
| Professional | | $2,082.94 | $3,354.81 | $7,150.00 |