- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,607.35 / $13,086.10 / $14,412.20
| Facility | | $4,607.35 | $13,086.10 | $14,412.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,849.50 / $2,791.70 / $2,966.19
| Professional | | $1,849.50 | $2,791.70 | $2,966.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,721.91 / $2,721.91 / $2,721.91
| Professional | | $2,721.91 | $2,721.91 | $2,721.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,336.31 / $4,533.80 / $10,427.19
| Facility | | $2,336.31 | $4,533.80 | $10,427.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,820.02 / $16,820.02 / $16,820.02
| Professional | | $16,820.02 | $16,820.02 | $16,820.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,664.11 / $4,711.00 / $8,619.39
| Professional | | $3,664.11 | $4,711.00 | $8,619.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.54 / $14,412.20 / $14,412.20
| Facility | | $5,370.54 | $14,412.20 | $14,412.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.23 / $2,966.19 / $14,412.20
| Professional | | $2,290.23 | $2,966.19 | $14,412.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,164.64 / $5,234.43 / $6,979.26
| Professional | | $5,164.64 | $5,234.43 | $6,979.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,431.57 / $4,409.38 / $11,579.94
| Facility | | $2,431.57 | $4,409.38 | $11,579.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,820.02 / $16,820.02 / $16,820.02
| Professional | | $16,820.02 | $16,820.02 | $16,820.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,489.63 / $3,489.63 / $3,838.59
| Facility | | $3,489.63 | $3,489.63 | $3,838.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,489.63 / $3,489.63 / $3,838.59
| Professional | | $3,489.63 | $3,489.63 | $3,838.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.64 / $2,093.78 / $5,234.45
| Professional | | $1,465.64 | $2,093.78 | $5,234.45 |