- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.59 / $1,713.59 / $1,713.59
| Facility | | $1,713.59 | $1,713.59 | $1,713.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,436.25 / $1,713.59 / $2,541.53
| Professional | | $1,436.25 | $1,713.59 | $2,541.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $5,971.10 / $18,629.07
| Facility | | $2,600.00 | $5,971.10 | $18,629.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,532.00 / $2,620.51 / $3,829.99
| Professional | | $1,532.00 | $2,620.51 | $3,829.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,162.70 / $5,064.39 / $6,521.99
| Facility | | $4,162.70 | $5,064.39 | $6,521.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,824.91 / $3,479.82 / $3,479.82
| Professional | | $2,824.91 | $3,479.82 | $3,479.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.78 / $2,268.50 / $2,749.47
| Facility | | $1,902.78 | $2,268.50 | $2,749.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,389.03 / $1,902.78 / $3,409.88
| Professional | | $1,389.03 | $1,902.78 | $3,409.88 |
- 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
- $3,175.39 / $3,175.39 / $3,334.16
| Professional | | $3,175.39 | $3,175.39 | $3,334.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,920.87 / $1,920.87 / $1,920.87
| Professional | | $1,920.87 | $1,920.87 | $1,920.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,971.10 / $18,629.07 / $18,629.07
| Facility | | $5,971.10 | $18,629.07 | $18,629.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.45 / $2,096.41 / $3,829.99
| Professional | | $1,467.45 | $2,096.41 | $3,829.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,486.01 / $2,096.41 / $3,294.48
| Professional | | $1,486.01 | $2,096.41 | $3,294.48 |