- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,134.76 / $9,153.50 / $25,452.20
| Facility | | $3,134.76 | $9,153.50 | $25,452.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,925.78 / $3,291.50 / $4,179.68
| Professional | | $2,925.78 | $3,291.50 | $4,179.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,224.60 / $5,224.60 / $5,224.60
| Professional | | $5,224.60 | $5,224.60 | $5,224.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.44 / $12,261.90 / $27,696.27
| Facility | | $3,438.44 | $12,261.90 | $27,696.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,364.01 / $6,364.01 / $7,624.80
| Professional | | $6,364.01 | $6,364.01 | $7,624.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,359.36 / $24,816.85 / $24,816.85
| Facility | | $8,359.36 | $24,816.85 | $24,816.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,018.51 / $26,018.51 / $39,184.50
| Professional | | $26,018.51 | $26,018.51 | $39,184.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,134.76 / $5,224.60 / $7,784.65
| Facility | | $3,134.76 | $5,224.60 | $7,784.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,224.60 / $5,224.60 / $6,530.75
| Professional | | $5,224.60 | $5,224.60 | $6,530.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,702.14 / $6,530.75 / $11,755.35
| Professional | | $4,702.14 | $6,530.75 | $11,755.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,134.76 / $5,224.60 / $15,783.54
| Facility | | $3,134.76 | $5,224.60 | $15,783.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,937.25 / $5,747.06 / $9,143.04
| Professional | | $4,937.25 | $5,747.06 | $9,143.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.33 / $2,194.33 / $5,224.60
| Professional | | $2,194.33 | $2,194.33 | $5,224.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.20 / $66.20 / $5,224.60
| Professional | | $66.20 | $66.20 | $5,224.60 |