- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,742.28 / $1,742.28 / $1,742.28
| Facility | | $1,742.28 | $1,742.28 | $1,742.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,742.28 / $1,742.28 / $2,611.04
| Professional | | $1,742.28 | $1,742.28 | $2,611.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.00 / $6,415.24 / $18,460.07
| Facility | | $2,034.00 | $6,415.24 | $18,460.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,668.98 / $2,579.14 / $3,894.11
| Professional | | $1,668.98 | $2,579.14 | $3,894.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,232.41 / $5,149.21 / $6,631.21
| Facility | | $4,232.41 | $5,149.21 | $6,631.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,611.11 / $3,538.10 / $3,538.10
| Professional | | $2,611.11 | $3,538.10 | $3,538.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,306.50 / $2,476.09 / $2,795.52
| Facility | | $2,306.50 | $2,476.09 | $2,795.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,807.55 / $2,476.09 / $4,437.38
| Professional | | $1,807.55 | $2,476.09 | $4,437.38 |
- 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
- $3,228.57 / $3,228.57 / $3,390.00
| Professional | | $3,228.57 | $3,228.57 | $3,390.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,018.91 / $2,018.91 / $2,018.91
| Professional | | $2,018.91 | $2,018.91 | $2,018.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,770.27 / $18,460.07 / $18,460.07
| Facility | | $7,770.27 | $18,460.07 | $18,460.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,557.64 / $2,131.52 / $3,894.11
| Professional | | $1,557.64 | $2,131.52 | $3,894.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,585.34 / $2,131.52 / $3,466.35
| Professional | | $1,585.34 | $2,131.52 | $3,466.35 |