- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,401.04 / $1,401.04 / $1,401.04
| Facility | | $1,401.04 | $1,401.04 | $1,401.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.04 / $1,401.04 / $2,400.17
| Professional | | $1,401.04 | $1,401.04 | $2,400.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,220.40 / $3,849.14 / $17,614.71
| Facility | | $1,220.40 | $3,849.14 | $17,614.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,424.47 / $2,259.19 / $3,131.42
| Professional | | $1,424.47 | $2,259.19 | $3,131.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,403.45 / $4,140.68 / $5,332.42
| Facility | | $3,403.45 | $4,140.68 | $5,332.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,099.69 / $2,845.13 / $2,845.13
| Professional | | $2,099.69 | $2,845.13 | $2,845.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,784.15 / $1,854.74 / $2,247.96
| Facility | | $1,784.15 | $1,854.74 | $2,247.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,302.43 / $1,784.15 / $4,212.38
| Professional | | $1,302.43 | $1,784.15 | $4,212.38 |
- 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
- $2,596.21 / $2,596.21 / $2,726.03
| Professional | | $2,596.21 | $2,596.21 | $2,726.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,814.05 / $1,814.05 / $1,814.05
| Professional | | $1,814.05 | $1,814.05 | $1,814.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,376.07 / $17,614.71 / $17,614.71
| Facility | | $7,376.07 | $17,614.71 | $17,614.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.57 / $1,714.03 / $3,131.42
| Professional | | $1,252.57 | $1,714.03 | $3,131.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.37 / $1,758.63 / $3,131.42
| Professional | | $1,325.37 | $1,758.63 | $3,131.42 |