- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,334.09 / $4,334.09 / $4,334.09
| Facility | | $4,334.09 | $4,334.09 | $4,334.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,334.09 / $4,442.75 / $7,139.76
| Professional | | $4,334.09 | $4,442.75 | $7,139.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,200.00 / $16,400.80 / $46,975.22
| Facility | | $5,200.00 | $16,400.80 | $46,975.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,523.51 / $7,152.60 / $9,687.01
| Professional | | $4,523.51 | $7,152.60 | $9,687.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,528.51 / $12,809.14 / $16,495.75
| Facility | | $10,528.51 | $12,809.14 | $16,495.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,495.36 / $8,801.35 / $8,801.35
| Professional | | $6,495.36 | $8,801.35 | $8,801.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,737.63 / $6,553.03 / $6,954.09
| Facility | | $5,737.63 | $6,553.03 | $6,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,783.71 / $6,553.03 / $11,743.88
| Professional | | $4,783.71 | $6,553.03 | $11,743.88 |
- 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
- $8,031.38 / $8,031.38 / $8,432.95
| Professional | | $8,031.38 | $8,031.38 | $8,432.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,886.31 / $5,886.31 / $5,886.31
| Professional | | $5,886.31 | $5,886.31 | $5,886.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,564.00 / $46,975.22 / $46,975.22
| Facility | | $20,564.00 | $46,975.22 | $46,975.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,874.80 / $5,302.34 / $9,687.01
| Professional | | $3,874.80 | $5,302.34 | $9,687.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,308.14 / $5,302.34 / $9,687.01
| Professional | | $4,308.14 | $5,302.34 | $9,687.01 |