- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,650.14 / $4,650.14 / $4,650.14
| Facility | | $4,650.14 | $4,650.14 | $4,650.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,650.14 / $4,823.79 / $7,738.06
| Professional | | $4,650.14 | $4,823.79 | $7,738.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,898.60 / $18,604.18 / $48,511.09
| Facility | | $5,898.60 | $18,604.18 | $48,511.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,622.32 / $7,316.97 / $10,393.40
| Professional | | $4,622.32 | $7,316.97 | $10,393.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,296.28 / $13,743.22 / $17,698.66
| Facility | | $11,296.28 | $13,743.22 | $17,698.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,969.03 / $9,443.16 / $9,443.16
| Professional | | $6,969.03 | $9,443.16 | $9,443.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,156.05 / $7,261.93 / $7,461.22
| Facility | | $6,156.05 | $7,261.93 | $7,461.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,301.21 / $5,301.21 / $12,525.00
| Professional | | $5,301.21 | $5,301.21 | $12,525.00 |
- 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
- $8,617.03 / $8,617.03 / $9,047.87
| Professional | | $8,617.03 | $8,617.03 | $9,047.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,850.74 / $6,850.74 / $6,850.74
| Professional | | $6,850.74 | $6,850.74 | $6,850.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,931.69 / $48,511.09 / $48,511.09
| Facility | | $21,931.69 | $48,511.09 | $48,511.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,157.35 / $5,689.01 / $10,393.40
| Professional | | $4,157.35 | $5,689.01 | $10,393.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,613.50 / $6,078.01 / $9,247.54
| Professional | | $4,613.50 | $6,078.01 | $9,247.54 |