- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.74 / $1,623.74 / $1,623.74
| Facility | | $1,623.74 | $1,623.74 | $1,623.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,623.74 / $1,712.55 / $2,957.12
| Professional | | $1,623.74 | $1,712.55 | $2,957.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,324.98 / $9,925.07 / $17,730.55
| Facility | | $3,324.98 | $9,925.07 | $17,730.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,696.91 / $2,760.65 / $3,629.18
| Professional | | $1,696.91 | $2,760.65 | $3,629.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,057.75 / $4,798.85 / $6,180.02
| Facility | | $4,057.75 | $4,798.85 | $6,180.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,433.44 / $3,297.37 / $3,297.37
| Professional | | $2,433.44 | $3,297.37 | $3,297.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,463.07 / $2,463.07 / $2,731.42
| Facility | | $2,463.07 | $2,463.07 | $2,731.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,798.04 / $2,463.07 / $4,414.13
| Professional | | $1,798.04 | $2,463.07 | $4,414.13 |
- 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
- $3,008.90 / $3,008.90 / $3,159.34
| Professional | | $3,008.90 | $3,008.90 | $3,159.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,713.03 / $2,713.03 / $2,713.03
| Professional | | $2,713.03 | $2,713.03 | $2,713.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,729.33 / $17,730.55 / $17,730.55
| Facility | | $7,729.33 | $17,730.55 | $17,730.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,451.67 / $1,986.49 / $3,629.18
| Professional | | $1,451.67 | $1,986.49 | $3,629.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,614.02 / $1,986.49 / $3,629.18
| Professional | | $1,614.02 | $1,986.49 | $3,629.18 |