- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,484.29 / $1,484.29 / $1,484.29
| Facility | | $1,484.29 | $1,484.29 | $1,484.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,484.29 / $1,554.79 / $2,028.07
| Professional | | $1,484.29 | $1,554.79 | $2,028.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,774.67 / $5,879.48 / $20,446.47
| Facility | | $1,774.67 | $5,879.48 | $20,446.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,462.42 / $2,481.90 / $3,317.51
| Professional | | $1,462.42 | $2,481.90 | $3,317.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,605.69 / $4,386.74 / $5,649.29
| Facility | | $3,605.69 | $4,386.74 | $5,649.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,224.46 / $2,618.90 / $2,618.90
| Professional | | $2,224.46 | $2,618.90 | $2,618.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,964.96 / $2,017.28 / $2,381.57
| Facility | | $1,964.96 | $2,017.28 | $2,381.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,472.61 / $2,017.28 / $4,290.75
| Professional | | $1,472.61 | $2,017.28 | $4,290.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,750.51 / $2,750.51 / $2,888.04
| Professional | | $2,750.51 | $2,750.51 | $2,888.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,497.60 / $2,497.60 / $2,497.60
| Professional | | $2,497.60 | $2,497.60 | $2,497.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,135.65 / $20,446.47 / $20,446.47
| Facility | | $8,135.65 | $20,446.47 | $20,446.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,293.38 / $1,694.79 / $3,317.51
| Professional | | $1,293.38 | $1,694.79 | $3,317.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.17 / $1,815.89 / $3,228.39
| Professional | | $1,342.17 | $1,815.89 | $3,228.39 |