- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,974.56 / $1,974.56 / $1,974.56
| Facility | | $1,974.56 | $1,974.56 | $1,974.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,736.98 / $1,974.56 / $2,849.16
| Professional | | $1,736.98 | $1,974.56 | $2,849.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,051.00 / $7,221.40 / $20,855.07
| Facility | | $3,051.00 | $7,221.40 | $20,855.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,765.32 / $3,051.00 / $4,413.29
| Professional | | $1,765.32 | $3,051.00 | $4,413.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,796.67 / $5,835.70 / $7,515.27
| Facility | | $4,796.67 | $5,835.70 | $7,515.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,255.14 / $4,009.79 / $4,009.79
| Professional | | $3,255.14 | $4,009.79 | $4,009.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,117.90 / $2,614.00 / $3,168.20
| Facility | | $2,117.90 | $2,614.00 | $3,168.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.07 / $1,546.07 / $4,123.88
| Professional | | $1,546.07 | $1,546.07 | $4,123.88 |
- 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
- $3,659.00 / $3,659.00 / $3,841.95
| Professional | | $3,659.00 | $3,659.00 | $3,841.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,534.73 / $2,534.73 / $2,636.79
| Professional | | $2,534.73 | $2,534.73 | $2,636.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.40 / $20,855.07 / $20,855.07
| Facility | | $7,221.40 | $20,855.07 | $20,855.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,690.94 / $2,415.69 / $4,413.29
| Professional | | $1,690.94 | $2,415.69 | $4,413.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,720.58 / $2,415.69 / $4,141.78
| Professional | | $1,720.58 | $2,415.69 | $4,141.78 |