- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,918.31 / $10,232.93
| Facility | | $3,019.95 | $6,918.31 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,884.03 / $3,715.35
| Professional | | $1,995.26 | $2,884.03 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $4,786.30
| Professional | | $1,513.56 | $1,513.56 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,128.61 / $13,182.57
| Facility | | $2,398.83 | $5,128.61 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $17,782.79 / $17,782.79
| Professional | | $3,715.35 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,025.60 / $14,125.38
| Facility | | $3,715.35 | $6,025.60 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,786.30 / $7,079.46
| Professional | | $3,890.45 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,630.78 / $6,606.93
| Professional | | $3,090.30 | $3,630.78 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,918.31 / $50,118.72
| Facility | | $4,786.30 | $6,918.31 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,801.89
| Professional | | $3,715.35 | $3,715.35 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,715.35 / $4,365.16
| Facility | | $3,311.31 | $3,715.35 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $4,897.79
| Professional | | $1,548.82 | $2,187.76 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,715.35 / $4,265.80
| Facility | | $3,090.30 | $3,715.35 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,715.35 / $7,244.36
| Professional | | $2,511.89 | $3,715.35 | $7,244.36 |