- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.92 / $1,686.01 / $2,401.29
| Professional | | $1,353.92 | $1,686.01 | $2,401.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Professional | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,425.75 / $8,150.52 / $9,400.24
| Facility | | $2,425.75 | $8,150.52 | $9,400.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.46 / $171.46 / $171.46
| Professional | | $171.46 | $171.46 | $171.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,917.39 / $2,917.39 / $2,917.39
| Facility | | $2,917.39 | $2,917.39 | $2,917.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,786.79 / $1,786.79 / $2,491.32
| Facility | | $1,786.79 | $1,786.79 | $2,491.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.77 / $1,786.79 / $2,345.16
| Professional | | $1,518.77 | $1,786.79 | $2,345.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,197.12 / $14,043.28 / $14,043.28
| Facility | | $4,197.12 | $14,043.28 | $14,043.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.13 / $1,941.47 / $2,917.39
| Facility | | $865.13 | $1,941.47 | $2,917.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.81 / $2,013.00 / $2,684.00
| Professional | | $310.81 | $2,013.00 | $2,684.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.13 / $1,786.79 / $2,917.39
| Facility | | $865.13 | $1,786.79 | $2,917.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.77 / $1,786.79 / $2,283.35
| Professional | | $1,518.77 | $1,786.79 | $2,283.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.15 / $1,457.67 / $1,922.52
| Professional | | $1,109.15 | $1,457.67 | $1,922.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,715.58 / $1,715.58 / $1,878.07
| Professional | | $1,715.58 | $1,715.58 | $1,878.07 |