- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,685.51 / $11,058.00 / $13,213.50
| Facility | | $2,685.51 | $11,058.00 | $13,213.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,895.65 / $2,559.13 / $2,685.51
| Professional | | $1,895.65 | $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
- $2,115.23 / $4,104.78 / $9,440.49
| Facility | | $2,115.23 | $4,104.78 | $9,440.49 |
- 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
- $3,518.02 / $10,901.90 / $13,213.50
| Facility | | $3,518.02 | $10,901.90 | $13,213.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,073.53 / $2,685.51 / $13,048.40
| Professional | | $2,073.53 | $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
- $2,201.48 / $3,992.07 / $10,484.64
| Facility | | $2,201.48 | $3,992.07 | $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 / $4,423.18
| Professional | | $1,326.96 | $1,895.65 | $4,423.18 |