- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,674.66 / $1,674.66 / $1,674.66
| Facility | | $1,674.66 | $1,674.66 | $1,674.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,674.66 / $1,766.24 / $3,049.86
| Professional | | $1,674.66 | $1,766.24 | $3,049.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,429.23 / $10,236.25 / $18,286.54
| Facility | | $3,429.23 | $10,236.25 | $18,286.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,750.12 / $2,847.21 / $3,742.97
| Professional | | $1,750.12 | $2,847.21 | $3,742.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.99 / $4,949.34 / $6,373.81
| Facility | | $4,184.99 | $4,949.34 | $6,373.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,509.76 / $3,400.77 / $3,400.77
| Professional | | $2,509.76 | $3,400.77 | $3,400.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,540.30 / $2,540.30 / $2,817.08
| Facility | | $2,540.30 | $2,540.30 | $2,817.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,854.42 / $2,540.30 / $4,552.50
| Professional | | $1,854.42 | $2,540.30 | $4,552.50 |
- 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
- $3,103.25 / $3,103.25 / $3,258.41
| Professional | | $3,103.25 | $3,103.25 | $3,258.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,798.10 / $2,798.10 / $2,798.10
| Professional | | $2,798.10 | $2,798.10 | $2,798.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,971.71 / $18,286.54 / $18,286.54
| Facility | | $7,971.71 | $18,286.54 | $18,286.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,497.19 / $2,048.78 / $3,742.97
| Professional | | $1,497.19 | $2,048.78 | $3,742.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,664.64 / $2,048.78 / $3,832.80
| Professional | | $1,664.64 | $2,048.78 | $3,832.80 |