- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,465.01 / $1,465.01 / $1,465.01
| Facility | | $1,465.01 | $1,465.01 | $1,465.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.01 / $1,465.01 / $2,427.92
| Professional | | $1,465.01 | $1,465.01 | $2,427.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,800.00 / $5,677.20 / $15,327.35
| Facility | | $1,800.00 | $5,677.20 | $15,327.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,431.54 / $2,240.39 / $3,274.42
| Professional | | $1,431.54 | $2,240.39 | $3,274.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,558.86 / $4,329.76 / $5,575.92
| Facility | | $3,558.86 | $4,329.76 | $5,575.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,415.14 / $2,975.05 / $2,975.05
| Professional | | $2,415.14 | $2,975.05 | $2,975.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,743.07 / $1,937.73 / $2,350.64
| Facility | | $1,743.07 | $1,937.73 | $2,350.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.44 / $1,272.44 / $3,818.25
| Professional | | $1,272.44 | $1,272.44 | $3,818.25 |
- 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
- $2,714.77 / $2,714.77 / $2,850.51
| Professional | | $2,714.77 | $2,714.77 | $2,850.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.11 / $2,238.11 / $2,238.11
| Professional | | $2,238.11 | $2,238.11 | $2,238.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,686.19 / $15,327.35 / $15,327.35
| Facility | | $6,686.19 | $15,327.35 | $15,327.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.77 / $1,792.31 / $3,274.42
| Professional | | $1,309.77 | $1,792.31 | $3,274.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,391.68 / $1,792.31 / $3,041.90
| Professional | | $1,391.68 | $1,792.31 | $3,041.90 |