- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,292.05 / $13,555.50 / $16,197.90
| Facility | | $3,292.05 | $13,555.50 | $16,197.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.80 / $3,137.13 / $3,292.05
| Professional | | $2,323.80 | $3,137.13 | $3,292.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,020.94 / $3,020.94 / $3,020.94
| Professional | | $3,020.94 | $3,020.94 | $3,020.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,592.96 / $5,034.89 / $12,852.35
| Facility | | $2,592.96 | $5,034.89 | $12,852.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,667.86 / $18,667.86 / $18,667.86
| Professional | | $18,667.86 | $18,667.86 | $18,667.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,066.65 / $5,228.55 / $9,566.31
| Professional | | $4,066.65 | $5,228.55 | $9,566.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,312.59 / $13,364.20 / $16,197.90
| Facility | | $4,312.59 | $13,364.20 | $16,197.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,541.85 / $3,292.05 / $15,995.50
| Professional | | $2,541.85 | $3,292.05 | $15,995.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,732.04 / $5,809.50 / $7,746.00
| Professional | | $5,732.04 | $5,809.50 | $7,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,592.96 / $5,034.89 / $12,852.35
| Facility | | $2,592.96 | $5,034.89 | $12,852.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,667.86 / $18,667.86 / $18,667.86
| Professional | | $18,667.86 | $18,667.86 | $18,667.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.00 / $3,873.00 / $3,873.00
| Facility | | $3,873.00 | $3,873.00 | $3,873.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,873.00 / $3,873.00 / $3,873.00
| Professional | | $3,873.00 | $3,873.00 | $3,873.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $2,323.80 / $5,171.22
| Professional | | $1,626.66 | $2,323.80 | $5,171.22 |