- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.14 / $2,093.14 / $2,093.14
| Facility | | $2,093.14 | $2,093.14 | $2,093.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,093.14 / $2,093.14 / $3,802.86
| Professional | | $2,093.14 | $2,093.14 | $3,802.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,125.53 / $6,703.92 / $28,917.53
| Facility | | $2,125.53 | $6,703.92 | $28,917.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,160.10 / $3,510.16 / $4,678.31
| Professional | | $2,160.10 | $3,510.16 | $4,678.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,084.71 / $6,186.14 / $7,966.58
| Facility | | $5,084.71 | $6,186.14 | $7,966.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,136.92 / $4,250.58 / $4,250.58
| Professional | | $3,136.92 | $4,250.58 | $4,250.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,770.97 / $2,853.06 / $3,358.45
| Facility | | $2,770.97 | $2,853.06 | $3,358.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,082.73 / $2,853.06 / $6,673.50
| Professional | | $2,082.73 | $2,853.06 | $6,673.50 |
- 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
- $3,878.73 / $3,878.73 / $4,072.67
| Professional | | $3,878.73 | $3,878.73 | $4,072.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,900.87 / $2,900.87 / $2,900.87
| Professional | | $2,900.87 | $2,900.87 | $2,900.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,685.96 / $28,917.53 / $28,917.53
| Facility | | $11,685.96 | $28,917.53 | $28,917.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,898.24 / $2,560.75 / $4,678.31
| Professional | | $1,898.24 | $2,560.75 | $4,678.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,157.94 / $2,560.75 / $4,565.92
| Professional | | $2,157.94 | $2,560.75 | $4,565.92 |