- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $8,212.79 / $15,040.40
| Facility | | $4,989.00 | $8,212.79 | $15,040.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,832.64 / $4,380.16 / $4,653.92
| Professional | | $3,832.64 | $4,380.16 | $4,653.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $3,958.57 / $15,440.06
| Facility | | $92.60 | $3,958.57 | $15,440.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,405.98 / $7,665.28 / $9,691.10
| Facility | | $6,405.98 | $7,665.28 | $9,691.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $8,034.86 / $21,353.28
| Facility | | $244.00 | $8,034.86 | $21,353.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.20 / $73.48 / $4,141.98
| Professional | | $66.20 | $73.48 | $4,141.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,475.20 / $5,475.20 / $5,475.20
| Professional | | $5,475.20 | $5,475.20 | $5,475.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,491.21 / $3,558.88 / $8,898.98
| Professional | | $2,491.21 | $3,558.88 | $8,898.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,285.12 / $3,285.12 / $4,653.92
| Professional | | $3,285.12 | $3,285.12 | $4,653.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,215.49 / $8,492.69 / $17,026.74
| Facility | | $4,215.49 | $8,492.69 | $17,026.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,668.70 / $6,668.70 / $7,989.86
| Professional | | $6,668.70 | $6,668.70 | $7,989.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,201.44 / $5,201.44 / $6,570.23
| Facility | | $5,201.44 | $5,201.44 | $6,570.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.58 / $3,285.12 / $6,192.45
| Professional | | $2,299.58 | $3,285.12 | $6,192.45 |