- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,292.05 / $5,588.74 / $11,803.40
| Facility | | $3,292.05 | $5,588.74 | $11,803.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,711.10 / $3,175.86 / $3,679.35
| Professional | | $2,711.10 | $3,175.86 | $3,679.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.30 / $5,112.35 / $34,740.81
| Facility | | $59.30 | $5,112.35 | $34,740.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,583.88 / $4,124.74 / $11,709.24
| Facility | | $3,583.88 | $4,124.74 | $11,709.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,531.41 / $5,422.20 / $6,855.21
| Facility | | $4,531.41 | $5,422.20 | $6,855.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,873.00 / $3,873.00 / $5,886.96
| Professional | | $3,873.00 | $3,873.00 | $5,886.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,873.00 / $3,873.00 / $3,873.00
| Professional | | $3,873.00 | $3,873.00 | $3,873.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.20 / $1,099.93 / $4,076.33
| Professional | | $573.20 | $1,099.93 | $4,076.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.80 / $2,323.80 / $3,292.05
| Professional | | $2,323.80 | $2,323.80 | $3,292.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,762.22 / $2,517.44 / $6,328.62
| Professional | | $1,762.22 | $2,517.44 | $6,328.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,675.48 / $6,545.37 / $11,253.00
| Facility | | $3,675.48 | $6,545.37 | $11,253.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,873.00 / $4,717.52 / $5,652.12
| Professional | | $3,873.00 | $4,717.52 | $5,652.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,485.70 / $3,485.70 / $3,485.70
| Facility | | $3,485.70 | $3,485.70 | $3,485.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $2,323.80 / $4,647.60
| Professional | | $1,626.66 | $2,323.80 | $4,647.60 |