- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.79 / $1,372.79 / $1,372.79
| Facility | | $1,372.79 | $1,372.79 | $1,372.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.61 / $1,372.79 / $1,769.12
| Professional | | $1,154.61 | $1,372.79 | $1,769.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,931.37 / $5,765.14 / $9,683.48
| Facility | | $1,931.37 | $5,765.14 | $9,683.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.32 / $1,981.59 / $2,211.31
| Professional | | $1,012.32 | $1,981.59 | $2,211.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,215.60 / $2,620.26 / $3,374.40
| Facility | | $2,215.60 | $2,620.26 | $3,374.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,691.73 / $1,691.73 / $2,313.96
| Professional | | $1,691.73 | $1,691.73 | $2,313.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.90 / $1,650.90 / $1,650.90
| Facility | | $1,650.90 | $1,650.90 | $1,650.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,403.27 / $1,650.90 / $2,410.13
| Professional | | $1,403.27 | $1,650.90 | $2,410.13 |
- 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
- $1,642.91 / $1,642.91 / $1,725.06
| Professional | | $1,642.91 | $1,642.91 | $1,725.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,220.37 / $9,683.48 / $9,683.48
| Facility | | $4,220.37 | $9,683.48 | $9,683.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.03 / $1,566.50 / $2,275.92
| Professional | | $943.03 | $1,566.50 | $2,275.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.29 / $914.02 / $2,162.13
| Facility | | $2.29 | $914.02 | $2,162.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.03 / $1,642.91 / $2,211.31
| Professional | | $943.03 | $1,642.91 | $2,211.31 |