- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,596.52 / $1,596.52 / $1,596.52
| Facility | | $1,596.52 | $1,596.52 | $1,596.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,596.52 / $1,683.86 / $2,907.57
| Professional | | $1,596.52 | $1,683.86 | $2,907.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,414.92 / $7,599.79 / $17,433.41
| Facility | | $2,414.92 | $7,599.79 | $17,433.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,668.47 / $2,646.19 / $3,568.35
| Professional | | $1,668.47 | $2,646.19 | $3,568.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,989.73 / $4,718.43 / $6,076.44
| Facility | | $3,989.73 | $4,718.43 | $6,076.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,392.66 / $3,242.10 / $3,242.10
| Professional | | $2,392.66 | $3,242.10 | $3,242.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.80 / $2,264.80 / $2,685.64
| Facility | | $2,264.80 | $2,264.80 | $2,685.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,653.30 / $2,264.80 / $4,340.25
| Professional | | $1,653.30 | $2,264.80 | $4,340.25 |
- 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
- $2,958.47 / $2,958.47 / $3,106.39
| Professional | | $2,958.47 | $2,958.47 | $3,106.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,626.54 / $2,626.54 / $2,626.54
| Professional | | $2,626.54 | $2,626.54 | $2,626.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,599.79 / $17,433.41 / $17,433.41
| Facility | | $7,599.79 | $17,433.41 | $17,433.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.34 / $1,953.19 / $3,568.35
| Professional | | $1,427.34 | $1,953.19 | $3,568.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,510.29 / $1,959.60 / $3,568.35
| Professional | | $1,510.29 | $1,959.60 | $3,568.35 |