- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,993.07 / $1,993.07 / $1,993.07
| Facility | | $1,993.07 | $1,993.07 | $1,993.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,993.07 / $1,993.07 / $3,289.00
| Professional | | $1,993.07 | $1,993.07 | $3,289.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,081.25 / $12,182.53 / $21,030.00
| Facility | | $4,081.25 | $12,182.53 | $21,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,102.33 / $3,420.21 / $4,454.64
| Professional | | $2,102.33 | $3,420.21 | $4,454.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,841.60 / $5,890.37 / $7,585.68
| Facility | | $4,841.60 | $5,890.37 | $7,585.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,115.40 / $4,047.36 / $4,047.36
| Professional | | $3,115.40 | $4,047.36 | $4,047.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,741.63 / $2,741.63 / $2,741.63
| Facility | | $2,741.63 | $2,741.63 | $2,741.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.39 / $2,741.63 / $5,230.13
| Professional | | $2,001.39 | $2,741.63 | $5,230.13 |
- 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
- $3,693.28 / $3,693.28 / $3,877.94
| Professional | | $3,693.28 | $3,693.28 | $3,877.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,352.69 / $3,352.69 / $3,352.69
| Professional | | $3,352.69 | $3,352.69 | $3,352.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,157.94 / $21,030.00 / $21,030.00
| Facility | | $9,157.94 | $21,030.00 | $21,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,781.86 / $2,543.17 / $4,454.64
| Professional | | $1,781.86 | $2,543.17 | $4,454.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,056.83 / $2,702.13 / $4,464.20
| Professional | | $2,056.83 | $2,702.13 | $4,464.20 |