- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,601.69 / $6,041.35 / $9,884.82
| Professional | | $2,601.69 | $6,041.35 | $9,884.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,381.39 / $8,456.90 / $8,456.90
| Professional | | $4,381.39 | $8,456.90 | $8,456.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $855.01 / $855.01 / $11,115.13
| Facility | | $855.01 | $855.01 | $11,115.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.01 / $855.01 / $11,115.13
| Professional | | $855.01 | $855.01 | $11,115.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,488.00 / $4,978.93 / $4,978.93
| Facility | | $4,488.00 | $4,978.93 | $4,978.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,232.09 / $4,232.09 / $11,898.75
| Professional | | $4,232.09 | $4,232.09 | $11,898.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,590.57 / $5,738.21 / $6,889.03
| Professional | | $4,590.57 | $5,738.21 | $6,889.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,925.77 / $4,925.77 / $5,738.21
| Professional | | $4,925.77 | $4,925.77 | $5,738.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,406.58 / $7,406.58 / $7,406.58
| Professional | | $7,406.58 | $7,406.58 | $7,406.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,488.00 / $4,978.93 / $4,978.93
| Facility | | $4,488.00 | $4,978.93 | $4,978.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,232.09 / $4,400.00 / $11,898.75
| Professional | | $4,232.09 | $4,400.00 | $11,898.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,275.46 / $3,743.35 / $5,759.00
| Professional | | $2,275.46 | $3,743.35 | $5,759.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,925.77 / $4,925.77 / $4,925.77
| Facility | | $4,925.77 | $4,925.77 | $4,925.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,925.77 / $4,925.77 / $5,738.21
| Professional | | $4,925.77 | $4,925.77 | $5,738.21 |