- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,484.69 / $1,484.69 / $1,484.69
| Facility | | $1,484.69 | $1,484.69 | $1,484.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,484.69 / $1,484.69 / $2,782.90
| Professional | | $1,484.69 | $1,484.69 | $2,782.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,688.20 / $5,324.58 / $20,966.93
| Facility | | $1,688.20 | $5,324.58 | $20,966.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.61 / $2,545.08 / $3,318.38
| Professional | | $1,651.61 | $2,545.08 | $3,318.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,606.66 / $4,387.91 / $5,650.80
| Facility | | $3,606.66 | $4,387.91 | $5,650.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,225.06 / $3,015.00 / $3,015.00
| Professional | | $2,225.06 | $3,015.00 | $3,015.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.49 / $2,482.86 / $2,482.86
| Facility | | $1,965.49 | $2,482.86 | $2,482.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,812.49 / $2,482.86 / $4,449.75
| Professional | | $1,812.49 | $2,482.86 | $4,449.75 |
- 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
- $2,751.23 / $2,751.23 / $2,888.79
| Professional | | $2,751.23 | $2,751.23 | $2,888.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,103.30 / $2,103.30 / $2,103.30
| Professional | | $2,103.30 | $2,103.30 | $2,103.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,791.44 / $20,966.93 / $20,966.93
| Facility | | $7,791.44 | $20,966.93 | $20,966.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,376.34 / $1,825.88 / $3,318.38
| Professional | | $1,376.34 | $1,825.88 | $3,318.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.64 / $2,182.50 / $2,488.46
| Facility | | $2.64 | $2,182.50 | $2,488.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.81 / $2,012.89 / $3,318.38
| Professional | | $1,475.81 | $2,012.89 | $3,318.38 |