- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.51 / $1,374.51 / $1,374.51
| Facility | | $1,374.51 | $1,374.51 | $1,374.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,322.63 / $1,374.51 / $1,649.41
| Professional | | $1,322.63 | $1,374.51 | $1,649.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.91 / $2,571.23 / $17,211.58
| Facility | | $1,844.91 | $2,571.23 | $17,211.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,525.00 / $2,364.19 / $2,907.65
| Professional | | $1,525.00 | $2,364.19 | $2,907.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.57 / $357.57 / $368.00
| Facility | | $357.57 | $357.57 | $368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,304.12 / $2,782.14 / $2,782.14
| Professional | | $2,304.12 | $2,782.14 | $2,782.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.91 / $1,850.09 / $3,065.16
| Facility | | $1,844.91 | $1,850.09 | $3,065.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.95 / $1,850.09 / $4,560.93
| Professional | | $271.95 | $1,850.09 | $4,560.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,534.09 / $2,534.09 / $2,534.09
| Professional | | $2,534.09 | $2,534.09 | $2,534.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,844.91 / $1,844.91 / $1,844.91
| Professional | | $1,844.91 | $1,844.91 | $1,844.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $17,211.58 / $17,211.58
| Facility | | $100.00 | $17,211.58 | $17,211.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.83 / $1,561.60 / $3,072.10
| Professional | | $1,453.83 | $1,561.60 | $3,072.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,498.99 / $2,392.32 / $3,123.19
| Professional | | $1,498.99 | $2,392.32 | $3,123.19 |