- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,486.64 / $11,370.90 / $11,514.80
| Facility | | $7,486.64 | $11,370.90 | $11,514.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $2,037.41 / $2,257.67
| Professional | | $455.43 | $2,037.41 | $2,257.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,147.54 / $2,147.54 / $2,147.54
| Professional | | $2,147.54 | $2,147.54 | $2,147.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,612.83 / $3,772.35 / $9,136.17
| Facility | | $2,612.83 | $3,772.35 | $9,136.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,270.67 / $13,270.67 / $13,270.67
| Professional | | $13,270.67 | $13,270.67 | $13,270.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,890.91 / $3,716.89 / $6,800.53
| Professional | | $2,890.91 | $3,716.89 | $6,800.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,486.64 / $11,370.90 / $11,370.90
| Facility | | $7,486.64 | $11,370.90 | $11,370.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $3,166.24 / $11,370.90
| Professional | | $455.43 | $3,166.24 | $11,370.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,074.81 / $4,129.88 / $5,506.50
| Professional | | $4,074.81 | $4,129.88 | $5,506.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,679.96 / $4,261.91 / $9,136.17
| Facility | | $2,679.96 | $4,261.91 | $9,136.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,270.67 / $13,270.67 / $13,270.67
| Professional | | $13,270.67 | $13,270.67 | $13,270.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,753.25 / $2,753.25 / $3,028.58
| Facility | | $2,753.25 | $2,753.25 | $3,028.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,753.25 / $2,753.25 / $3,028.58
| Professional | | $2,753.25 | $2,753.25 | $3,028.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.36 / $1,651.95 / $3,854.55
| Professional | | $1,156.36 | $1,651.95 | $3,854.55 |