- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,596.86 / $2,711.58 / $4,391.75
| Professional | | $1,596.86 | $2,711.58 | $4,391.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,593.34 / $3,593.34 / $4,491.68
| Professional | | $3,593.34 | $3,593.34 | $4,491.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.27 / $388.27 / $5,047.51
| Facility | | $388.27 | $388.27 | $5,047.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.27 / $388.27 / $5,047.51
| Professional | | $388.27 | $388.27 | $5,047.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $2,200.00 / $2,244.00
| Facility | | $2,200.00 | $2,200.00 | $2,244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.00 / $2,200.00 / $4,104.00
| Professional | | $1,870.00 | $2,200.00 | $4,104.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,936.41 / $2,420.51 / $3,276.40
| Professional | | $1,936.41 | $2,420.51 | $3,276.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,420.51 / $3,307.42 / $3,514.13
| Professional | | $2,420.51 | $3,307.42 | $3,514.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $2,200.00 / $2,244.00
| Facility | | $2,200.00 | $2,200.00 | $2,244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.00 / $2,200.00 / $4,104.00
| Professional | | $1,870.00 | $2,200.00 | $4,104.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,508.92 / $2,640.61 / $3,772.30
| Professional | | $1,508.92 | $2,640.61 | $3,772.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,307.42 / $3,307.42 / $3,307.42
| Facility | | $3,307.42 | $3,307.42 | $3,307.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,420.51 / $3,307.42 / $3,514.13
| Professional | | $2,420.51 | $3,307.42 | $3,514.13 |