- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,032.46 / $7,080.67 / $19,464.20
| Facility | | $2,032.46 | $7,080.67 | $19,464.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,476.92 / $2,249.26 / $2,303.46
| Professional | | $1,476.92 | $2,249.26 | $2,303.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $13,576.85
| Facility | | $244.00 | $614.00 | $13,576.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $39.84 / $4,444.31
| Professional | | $33.20 | $39.84 | $4,444.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $1,959.29 / $7,642.06
| Facility | | $92.60 | $1,959.29 | $7,642.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,233.03 / $1,761.47 / $4,404.56
| Professional | | $1,233.03 | $1,761.47 | $4,404.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.89 / $3,815.34 / $8,869.00
| Facility | | $1,787.89 | $3,815.34 | $8,869.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,709.95 / $2,980.95 / $3,658.43
| Professional | | $2,709.95 | $2,980.95 | $3,658.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,438.96 / $3,116.44 / $5,176.00
| Professional | | $2,438.96 | $3,116.44 | $5,176.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,715.31 / $12,872.26 / $12,872.26
| Facility | | $4,715.31 | $12,872.26 | $12,872.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,495.55 / $13,495.55 / $20,324.63
| Professional | | $13,495.55 | $13,495.55 | $20,324.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,167.96 / $3,251.94 / $7,190.32
| Facility | | $2,167.96 | $3,251.94 | $7,190.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,709.95 / $2,980.95 / $4,064.93
| Professional | | $2,709.95 | $2,980.95 | $4,064.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.18 / $1,219.48 / $7,551.55
| Professional | | $1,138.18 | $1,219.48 | $7,551.55 |