- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,196.84 / $2,196.84 / $2,196.84
| Facility | | $2,196.84 | $2,196.84 | $2,196.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,142.69 / $2,196.84 / $3,304.15
| Professional | | $2,142.69 | $2,196.84 | $3,304.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,363.00 / $7,452.90 / $22,879.56
| Facility | | $2,363.00 | $7,452.90 | $22,879.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,078.19 / $3,218.08 / $4,910.10
| Professional | | $2,078.19 | $3,218.08 | $4,910.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,336.63 / $6,492.63 / $8,361.28
| Facility | | $5,336.63 | $6,492.63 | $8,361.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,621.59 / $4,461.18 / $4,461.18
| Professional | | $3,621.59 | $4,461.18 | $4,461.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,728.17 / $2,908.28 / $3,524.87
| Facility | | $2,728.17 | $2,908.28 | $3,524.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,991.56 / $1,991.56 / $5,087.25
| Professional | | $1,991.56 | $1,991.56 | $5,087.25 |
- 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
- $4,070.90 / $4,070.90 / $4,274.43
| Professional | | $4,070.90 | $4,070.90 | $4,274.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,789.25 / $2,789.25 / $2,789.25
| Professional | | $2,789.25 | $2,789.25 | $2,789.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,908.15 / $22,879.56 / $22,879.56
| Facility | | $8,908.15 | $22,879.56 | $22,879.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,964.04 / $2,687.63 / $4,910.10
| Professional | | $1,964.04 | $2,687.63 | $4,910.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,978.08 / $2,687.63 / $4,070.90
| Professional | | $1,978.08 | $2,687.63 | $4,070.90 |