- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,899.69 / $3,899.69 / $3,899.69
| Facility | | $3,899.69 | $3,899.69 | $3,899.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,899.69 / $3,899.69 / $6,775.11
| Professional | | $3,899.69 | $3,899.69 | $6,775.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,779.89 / $15,075.80 / $42,111.30
| Facility | | $4,779.89 | $15,075.80 | $42,111.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,020.92 / $6,377.16 / $8,716.10
| Professional | | $4,020.92 | $6,377.16 | $8,716.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,473.25 / $11,525.30 / $14,842.41
| Facility | | $9,473.25 | $11,525.30 | $14,842.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,844.36 / $7,919.21 / $7,919.21
| Professional | | $5,844.36 | $7,919.21 | $7,919.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,162.56 / $6,300.68 / $6,300.68
| Facility | | $5,162.56 | $6,300.68 | $6,300.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,599.50 / $6,300.68 / $11,291.63
| Professional | | $4,599.50 | $6,300.68 | $11,291.63 |
- 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
- $7,226.40 / $7,226.40 / $7,587.72
| Professional | | $7,226.40 | $7,226.40 | $7,587.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,120.60 / $5,120.60 / $5,120.60
| Professional | | $5,120.60 | $5,120.60 | $5,120.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,772.20 / $42,111.30 / $42,111.30
| Facility | | $19,772.20 | $42,111.30 | $42,111.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,486.44 / $4,770.89 / $8,716.10
| Professional | | $3,486.44 | $4,770.89 | $8,716.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,876.36 / $4,770.89 / $8,059.76
| Professional | | $3,876.36 | $4,770.89 | $8,059.76 |