- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.33 / $1,454.33 / $1,454.33
| Facility | | $1,454.33 | $1,454.33 | $1,454.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,454.33 / $1,454.33 / $2,425.41
| Professional | | $1,454.33 | $1,454.33 | $2,425.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.59 / $4,827.47 / $18,273.58
| Facility | | $1,530.59 | $4,827.47 | $18,273.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.63 / $2,282.94 / $3,250.53
| Professional | | $1,445.63 | $2,282.94 | $3,250.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,532.89 / $4,298.17 / $5,535.23
| Facility | | $3,532.89 | $4,298.17 | $5,535.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,179.56 / $2,953.33 / $2,953.33
| Professional | | $2,179.56 | $2,953.33 | $2,953.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,925.28 / $2,289.62 / $2,333.48
| Facility | | $1,925.28 | $2,289.62 | $2,333.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.42 / $1,671.42 / $4,103.25
| Professional | | $1,671.42 | $1,671.42 | $4,103.25 |
- 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
- $2,694.97 / $2,694.97 / $2,829.72
| Professional | | $2,694.97 | $2,694.97 | $2,829.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,942.08 / $2,405.80 / $2,405.80
| Professional | | $1,942.08 | $2,405.80 | $2,405.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,185.02 / $18,273.58 / $18,273.58
| Facility | | $7,185.02 | $18,273.58 | $18,273.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.21 / $1,779.23 / $3,250.53
| Professional | | $1,300.21 | $1,779.23 | $3,250.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,439.45 / $1,779.23 / $3,201.89
| Professional | | $1,439.45 | $1,779.23 | $3,201.89 |