- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.82 / $1,377.82 / $1,377.82
| Facility | | $1,377.82 | $1,377.82 | $1,377.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.82 / $1,377.82 / $2,152.13
| Professional | | $1,377.82 | $1,377.82 | $2,152.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,921.23 / $6,075.57 / $14,660.64
| Facility | | $1,921.23 | $6,075.57 | $14,660.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.91 / $2,053.41 / $3,079.52
| Professional | | $1,355.91 | $2,053.41 | $3,079.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,443.18 / $4,072.05 / $5,244.04
| Facility | | $3,443.18 | $4,072.05 | $5,244.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,064.89 / $2,899.77 / $2,899.77
| Professional | | $2,064.89 | $2,899.77 | $2,899.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,495.13 / $2,373.71 / $2,373.71
| Facility | | $1,495.13 | $2,373.71 | $2,373.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.65 / $2,373.71 / $3,469.50
| Professional | | $2,017.65 | $2,373.71 | $3,469.50 |
- 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
- $2,553.19 / $2,553.19 / $2,680.85
| Professional | | $2,553.19 | $2,553.19 | $2,680.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,075.57 / $14,660.64 / $14,660.64
| Facility | | $6,075.57 | $14,660.64 | $14,660.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.81 / $1,685.62 / $3,079.52
| Professional | | $1,231.81 | $1,685.62 | $3,079.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.81 / $1,685.62 / $3,079.52
| Professional | | $1,231.81 | $1,685.62 | $3,079.52 |