- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,859.51 / $3,927.79 / $5,296.57
| Professional | | $2,859.51 | $3,927.79 | $5,296.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,864.68 / $4,864.68 / $5,307.95
| Professional | | $4,864.68 | $4,864.68 | $5,307.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.11 / $1,898.77 / $2,189.92
| Facility | | $565.11 | $1,898.77 | $2,189.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.44 / $374.93 / $374.93
| Professional | | $337.44 | $374.93 | $374.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,796.50 / $6,796.50 / $6,796.50
| Facility | | $6,796.50 | $6,796.50 | $6,796.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,900.00 / $2,900.00 / $6,630.73
| Facility | | $2,900.00 | $2,900.00 | $6,630.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,465.00 / $2,900.00 / $4,968.00
| Professional | | $2,465.00 | $2,900.00 | $4,968.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,071.28 / $30,495.32 / $31,607.17
| Facility | | $11,071.28 | $30,495.32 | $31,607.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.65 / $3,161.76 / $5,102.34
| Facility | | $679.65 | $3,161.76 | $5,102.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.28 / $1,860.57 / $5,687.64
| Professional | | $625.28 | $1,860.57 | $5,687.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.65 / $2,900.00 / $4,864.24
| Facility | | $679.65 | $2,900.00 | $4,864.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.34 / $2,900.00 / $2,987.00
| Professional | | $480.34 | $2,900.00 | $2,987.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,294.04 / $2,856.46 / $4,134.60
| Professional | | $2,294.04 | $2,856.46 | $4,134.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,336.99 / $5,415.20 / $5,415.20
| Professional | | $4,336.99 | $5,415.20 | $5,415.20 |