- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,870.82 / $1,870.82 / $1,870.82
| Facility | | $1,870.82 | $1,870.82 | $1,870.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.82 / $1,973.14 / $3,407.14
| Professional | | $1,870.82 | $1,973.14 | $3,407.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,830.93 / $11,435.33 / $20,504.11
| Facility | | $3,830.93 | $11,435.33 | $20,504.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,955.12 / $3,180.73 / $4,181.42
| Professional | | $1,955.12 | $3,180.73 | $4,181.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,675.21 / $5,529.10 / $7,120.43
| Facility | | $4,675.21 | $5,529.10 | $7,120.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,084.11 / $3,599.17 / $3,599.17
| Professional | | $3,084.11 | $3,599.17 | $3,599.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.80 / $2,448.80 / $3,147.06
| Facility | | $2,448.80 | $2,448.80 | $3,147.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,787.62 / $2,448.80 / $5,085.75
| Professional | | $1,787.62 | $2,448.80 | $5,085.75 |
- 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
- $3,466.77 / $3,466.77 / $3,640.11
| Professional | | $3,466.77 | $3,466.77 | $3,640.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,557.40 / $2,557.40 / $2,557.40
| Professional | | $2,557.40 | $2,557.40 | $2,557.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,905.37 / $20,504.11 / $20,504.11
| Facility | | $8,905.37 | $20,504.11 | $20,504.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,672.57 / $2,288.77 / $4,181.42
| Professional | | $1,672.57 | $2,288.77 | $4,181.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,769.78 / $2,288.77 / $4,181.42
| Professional | | $1,769.78 | $2,288.77 | $4,181.42 |