- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $9,549.93
| Facility | | $2,691.53 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,511.89 / $3,388.44
| Professional | | $1,905.46 | $2,511.89 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $1,905.46
| Professional | | $7.41 | $7.41 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,128.61 / $12,022.64
| Facility | | $2,089.30 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $15,488.17 / $15,488.17
| Professional | | $3,235.94 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,248.07 / $12,302.69
| Facility | | $3,235.94 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,168.69 / $6,165.95
| Professional | | $3,388.44 | $4,168.69 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,162.28 / $5,754.40
| Professional | | $2,691.53 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,025.60 / $50,118.72
| Facility | | $4,168.69 | $6,025.60 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,311.31
| Professional | | $3,235.94 | $3,235.94 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,235.94 / $3,801.89
| Facility | | $2,884.03 | $3,235.94 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $4,265.80
| Professional | | $1,348.96 | $1,905.46 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,235.94 / $3,715.35
| Facility | | $2,691.53 | $3,235.94 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,235.94 / $6,309.57
| Professional | | $2,187.76 | $3,235.94 | $6,309.57 |