- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.73 / $1,664.73 / $1,664.73
| Facility | | $1,664.73 | $1,664.73 | $1,664.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,655.27 / $1,664.73 / $2,145.34
| Professional | | $1,655.27 | $1,664.73 | $2,145.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,891.62 / $6,266.94 / $18,404.34
| Facility | | $1,891.62 | $6,266.94 | $18,404.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.49 / $2,299.29 / $3,720.79
| Professional | | $1,419.49 | $2,299.29 | $3,720.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,044.01 / $4,920.00 / $6,336.04
| Facility | | $4,044.01 | $4,920.00 | $6,336.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,744.37 / $3,493.39 / $3,493.39
| Professional | | $2,744.37 | $3,493.39 | $3,493.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,815.81 / $2,203.83 / $2,671.08
| Facility | | $1,815.81 | $2,203.83 | $2,671.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.54 / $1,815.81 / $3,733.50
| Professional | | $1,325.54 | $1,815.81 | $3,733.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,084.86 / $3,084.86 / $3,239.10
| Professional | | $3,084.86 | $3,084.86 | $3,239.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,921.55 / $1,921.55 / $1,921.55
| Professional | | $1,921.55 | $1,921.55 | $1,921.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,537.62 / $18,404.34 / $18,404.34
| Facility | | $6,537.62 | $18,404.34 | $18,404.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,267.21 / $1,900.81 / $3,720.79
| Professional | | $1,267.21 | $1,900.81 | $3,720.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,316.35 / $2,291.21 / $3,161.98
| Professional | | $1,316.35 | $2,291.21 | $3,161.98 |