- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.37 / $2,326.37 / $16,768.75
| Facility | | $2,326.37 | $2,326.37 | $16,768.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,326.37 / $2,326.37 / $2,326.37
| Professional | | $2,326.37 | $2,326.37 | $2,326.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.84 / $5,943.56 / $7,375.47
| Facility | | $2,448.84 | $5,943.56 | $7,375.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,226.21 / $2,671.46 / $3,523.77
| Professional | | $2,226.21 | $2,671.46 | $3,523.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,789.86 / $3,317.68 / $7,072.16
| Facility | | $2,789.86 | $3,317.68 | $7,072.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,554.44 / $2,554.44 / $2,554.44
| Facility | | $2,554.44 | $2,554.44 | $2,554.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,554.44 / $2,554.44 / $2,554.44
| Professional | | $2,554.44 | $2,554.44 | $2,554.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.00 / $3,472.00 / $8,090.00
| Facility | | $1,909.00 | $3,472.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.75 / $143.75 / $169.12
| Professional | | $143.75 | $143.75 | $169.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.41 / $2,326.37 / $4,831.41
| Professional | | $1,977.41 | $2,326.37 | $4,831.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.06 / $2,600.06 / $11,809.10
| Facility | | $2,600.06 | $2,600.06 | $11,809.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,349.17 / $2,736.91 / $3,523.77
| Professional | | $2,349.17 | $2,736.91 | $3,523.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,349.17 / $2,736.91 / $3,288.95
| Professional | | $2,349.17 | $2,736.91 | $3,288.95 |