- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,685.51 / $10,901.90 / $13,213.50
| Facility | | $2,685.51 | $10,901.90 | $13,213.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.00 / $2,559.13 / $2,685.51
| Professional | | $477.00 | $2,559.13 | $2,685.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,464.35 / $2,464.35 / $2,464.35
| Professional | | $2,464.35 | $2,464.35 | $2,464.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,998.29 / $4,329.14 / $10,484.64
| Facility | | $2,998.29 | $4,329.14 | $10,484.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,228.40 / $15,228.40 / $15,228.40
| Professional | | $15,228.40 | $15,228.40 | $15,228.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,317.39 / $4,265.22 / $7,803.77
| Professional | | $3,317.39 | $4,265.22 | $7,803.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,254.20 / $8,969.60 / $13,048.40
| Facility | | $3,254.20 | $8,969.60 | $13,048.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.00 / $2,685.51 / $13,048.40
| Professional | | $477.00 | $2,685.51 | $13,048.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,675.93 / $4,739.13 / $6,318.84
| Professional | | $4,675.93 | $4,739.13 | $6,318.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,075.09 / $4,890.29 / $10,484.64
| Facility | | $3,075.09 | $4,890.29 | $10,484.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,228.40 / $15,228.40 / $15,228.40
| Professional | | $15,228.40 | $15,228.40 | $15,228.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,159.42 / $3,159.42 / $3,475.36
| Facility | | $3,159.42 | $3,159.42 | $3,475.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,159.42 / $3,159.42 / $3,475.36
| Professional | | $3,159.42 | $3,159.42 | $3,475.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $5,781.74
| Professional | | $1,326.96 | $1,895.65 | $5,781.74 |