- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,282.56 / $2,282.56 / $2,282.56
| Facility | | $2,282.56 | $2,282.56 | $2,282.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,239.19 / $2,282.56 / $3,740.83
| Professional | | $2,239.19 | $2,282.56 | $3,740.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,796.75 / $8,820.95 / $24,060.65
| Facility | | $2,796.75 | $8,820.95 | $24,060.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,259.05 / $3,521.11 / $5,101.67
| Professional | | $2,259.05 | $3,521.11 | $5,101.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,544.85 / $6,745.95 / $8,687.51
| Facility | | $5,544.85 | $6,745.95 | $8,687.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,762.88 / $4,635.25 / $4,635.25
| Professional | | $3,762.88 | $4,635.25 | $4,635.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,780.72 / $3,021.72 / $3,662.38
| Facility | | $2,780.72 | $3,021.72 | $3,662.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,029.93 / $2,780.72 / $5,316.38
| Professional | | $2,029.93 | $2,780.72 | $5,316.38 |
- 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
- $4,229.72 / $4,229.72 / $4,441.22
| Professional | | $4,229.72 | $4,229.72 | $4,441.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,827.32 / $2,827.32 / $2,827.32
| Professional | | $2,827.32 | $2,827.32 | $2,827.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,309.32 / $24,060.65 / $24,060.65
| Facility | | $9,309.32 | $24,060.65 | $24,060.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,040.67 / $2,792.49 / $5,101.67
| Professional | | $2,040.67 | $2,792.49 | $5,101.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,988.96 / $2,792.49 / $5,843.77
| Professional | | $1,988.96 | $2,792.49 | $5,843.77 |