- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,729.79 / $1,729.79 / $1,729.79
| Facility | | $1,729.79 | $1,729.79 | $1,729.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,729.79 / $1,924.20 / $3,668.13
| Professional | | $1,729.79 | $1,924.20 | $3,668.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,542.14 / $10,573.29 / $22,464.46
| Facility | | $3,542.14 | $10,573.29 | $22,464.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,975.10 / $3,205.42 / $4,059.51
| Professional | | $1,975.10 | $3,205.42 | $4,059.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,322.77 / $5,112.29 / $6,583.66
| Facility | | $4,322.77 | $5,112.29 | $6,583.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,678.33 / $3,512.73 / $3,512.73
| Professional | | $2,678.33 | $3,512.73 | $3,512.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,001.57 / $3,001.57 / $3,001.57
| Facility | | $3,001.57 | $3,001.57 | $3,001.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,191.15 / $3,001.57 / $5,907.75
| Professional | | $2,191.15 | $3,001.57 | $5,907.75 |
- 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
- $3,205.42 / $3,205.42 / $3,365.69
| Professional | | $3,205.42 | $3,205.42 | $3,365.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,924.97 / $2,924.97 / $2,924.97
| Professional | | $2,924.97 | $2,924.97 | $2,924.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,344.70 / $22,464.46 / $22,464.46
| Facility | | $10,344.70 | $22,464.46 | $22,464.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,645.92 / $2,434.85 / $3,866.20
| Professional | | $1,645.92 | $2,434.85 | $3,866.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,826.14 / $2,434.85 / $3,866.20
| Professional | | $1,826.14 | $2,434.85 | $3,866.20 |