- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,104.81 / $3,104.81 / $3,104.81
| Facility | | $3,104.81 | $3,104.81 | $3,104.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,104.81 / $3,450.94 / $5,492.79
| Professional | | $3,104.81 | $3,450.94 | $5,492.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,712.05 / $11,707.81 / $35,737.98
| Facility | | $3,712.05 | $11,707.81 | $35,737.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,469.74 / $5,410.34 / $6,939.48
| Professional | | $3,469.74 | $5,410.34 | $6,939.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,542.31 / $9,176.09 / $11,817.06
| Facility | | $7,542.31 | $9,176.09 | $11,817.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,653.07 / $6,305.02 / $6,305.02
| Professional | | $4,653.07 | $6,305.02 | $6,305.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,110.22 / $4,697.47 / $4,981.68
| Facility | | $4,110.22 | $4,697.47 | $4,981.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,429.16 / $3,429.16 / $8,418.37
| Professional | | $3,429.16 | $3,429.16 | $8,418.37 |
- 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
- $5,753.43 / $5,753.43 / $6,041.10
| Professional | | $5,753.43 | $5,753.43 | $6,041.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,875.25 / $4,875.25 / $4,875.25
| Professional | | $4,875.25 | $4,875.25 | $4,875.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,741.13 / $35,737.98 / $35,737.98
| Facility | | $14,741.13 | $35,737.98 | $35,737.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,925.83 / $3,798.42 / $6,939.48
| Professional | | $2,925.83 | $3,798.42 | $6,939.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,775.79 / $3,798.42 / $7,037.63
| Professional | | $2,775.79 | $3,798.42 | $7,037.63 |