- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.43 / $1,182.43 / $1,182.43
| Facility | | $1,182.43 | $1,182.43 | $1,182.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.43 / $1,182.43 / $1,755.11
| Professional | | $1,182.43 | $1,182.43 | $1,755.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.70 / $3,528.38 / $11,244.11
| Facility | | $1,118.70 | $3,528.38 | $11,244.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.70 / $1,694.60 / $2,642.81
| Professional | | $1,118.70 | $1,694.60 | $2,642.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,872.39 / $3,494.60 / $4,500.38
| Facility | | $2,872.39 | $3,494.60 | $4,500.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.08 / $2,401.19 / $2,401.19
| Professional | | $1,772.08 | $2,401.19 | $2,401.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.36 / $1,606.19 / $1,897.24
| Facility | | $1,565.36 | $1,606.19 | $1,897.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,172.52 / $1,606.19 / $2,878.50
| Professional | | $1,172.52 | $1,606.19 | $2,878.50 |
- 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
- $2,191.12 / $2,191.12 / $2,300.67
| Professional | | $2,191.12 | $2,191.12 | $2,300.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.52 / $1,326.52 / $1,326.52
| Professional | | $1,326.52 | $1,326.52 | $1,326.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,040.37 / $11,244.11 / $11,244.11
| Facility | | $5,040.37 | $11,244.11 | $11,244.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.63 / $1,446.59 / $2,642.81
| Professional | | $1,041.63 | $1,446.59 | $2,642.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.63 / $1,521.69 / $2,457.88
| Professional | | $1,041.63 | $1,521.69 | $2,457.88 |