- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,193.12 / $4,193.12 / $35,222.19
| Facility | | $4,193.12 | $4,193.12 | $35,222.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,485.85 / $4,193.12 / $4,193.12
| Professional | | $3,485.85 | $4,193.12 | $4,193.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,864.74 / $4,673.06 / $6,062.34
| Facility | | $3,864.74 | $4,673.06 | $6,062.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,782.67 / $4,294.16 / $8,244.78
| Professional | | $3,782.67 | $4,294.16 | $8,244.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $10.00 / $25.01
| Professional | | $8.00 | $10.00 | $25.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,294.16 / $4,294.16 / $4,294.16
| Facility | | $4,294.16 | $4,294.16 | $4,294.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,294.16 / $4,294.16 / $4,294.16
| Professional | | $4,294.16 | $4,294.16 | $4,294.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.93 / $393.93 / $393.93
| Professional | | $393.93 | $393.93 | $393.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,007.77 / $10,103.90 / $18,944.81
| Facility | | $6,007.77 | $10,103.90 | $18,944.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,681.83 / $19,197.41 / $22,733.78
| Professional | | $17,681.83 | $19,197.41 | $22,733.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $85.00 / $85.00
| Professional | | $85.00 | $85.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,193.12 / $4,685.64 / $5,999.19
| Facility | | $4,193.12 | $4,685.64 | $5,999.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,294.16 / $4,294.16 / $5,051.95
| Professional | | $4,294.16 | $4,294.16 | $5,051.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,209.96 / $4,209.96 / $8,676.73
| Professional | | $4,209.96 | $4,209.96 | $8,676.73 |