- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,663.80 / $1,663.80 / $1,663.80
| Facility | | $1,663.80 | $1,663.80 | $1,663.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,420.77 / $1,663.80 / $2,372.52
| Professional | | $1,420.77 | $1,663.80 | $2,372.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $5,984.51 / $18,087.81
| Facility | | $2,000.00 | $5,984.51 | $18,087.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,487.49 / $2,317.98 / $3,718.72
| Professional | | $1,487.49 | $2,317.98 | $3,718.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,041.76 / $4,917.26 / $6,332.50
| Facility | | $4,041.76 | $4,917.26 | $6,332.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,493.48 / $3,378.72 / $3,378.72
| Professional | | $2,493.48 | $3,378.72 | $3,378.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,050.41 / $2,202.60 / $2,669.58
| Facility | | $2,050.41 | $2,202.60 | $2,669.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,496.80 / $1,496.80 / $3,373.13
| Professional | | $1,496.80 | $1,496.80 | $3,373.13 |
- 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
- $3,083.14 / $3,083.14 / $3,237.30
| Professional | | $3,083.14 | $3,083.14 | $3,237.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,814.48 / $1,814.48 / $1,814.48
| Professional | | $1,814.48 | $1,814.48 | $1,814.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,984.51 / $18,087.81 / $18,087.81
| Facility | | $5,984.51 | $18,087.81 | $18,087.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,424.81 / $2,035.50 / $3,718.72
| Professional | | $1,424.81 | $2,035.50 | $3,718.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,449.79 / $2,035.50 / $3,384.89
| Professional | | $1,449.79 | $2,035.50 | $3,384.89 |