- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,938.87 / $1,938.87 / $1,938.87
| Facility | | $1,938.87 | $1,938.87 | $1,938.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,938.87 / $2,044.89 / $3,531.04
| Professional | | $1,938.87 | $2,044.89 | $3,531.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,970.28 / $11,851.29 / $21,171.57
| Facility | | $3,970.28 | $11,851.29 | $21,171.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,026.24 / $3,296.42 / $4,333.52
| Professional | | $2,026.24 | $3,296.42 | $4,333.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,845.27 / $5,730.22 / $7,379.44
| Facility | | $4,845.27 | $5,730.22 | $7,379.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,030.66 / $3,937.32 / $3,937.32
| Professional | | $3,030.66 | $3,937.32 | $3,937.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.06 / $2,941.06 / $2,941.06
| Facility | | $2,941.06 | $2,941.06 | $2,941.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,146.96 / $2,146.96 / $5,270.63
| Professional | | $2,146.96 | $2,146.96 | $5,270.63 |
- 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
- $3,592.86 / $3,592.86 / $3,772.50
| Professional | | $3,592.86 | $3,592.86 | $3,772.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,378.84 / $3,378.84 / $3,378.84
| Professional | | $3,378.84 | $3,378.84 | $3,378.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,229.31 / $21,171.57 / $21,171.57
| Facility | | $9,229.31 | $21,171.57 | $21,171.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,733.41 / $2,474.01 / $4,333.52
| Professional | | $1,733.41 | $2,474.01 | $4,333.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,998.89 / $2,474.01 / $4,333.52
| Professional | | $1,998.89 | $2,474.01 | $4,333.52 |