- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,644.68 / $8,307.11 / $14,628.90
| Facility | | $3,644.68 | $8,307.11 | $14,628.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,769.04 / $3,435.17 / $4,440.91
| Professional | | $2,769.04 | $3,435.17 | $4,440.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.58 / $1,912.00 / $4,284.17
| Professional | | $1,455.58 | $1,912.00 | $4,284.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,395.99 / $7,335.34 / $18,248.93
| Facility | | $3,395.99 | $7,335.34 | $18,248.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,364.01 / $25,182.57 / $25,182.57
| Professional | | $6,364.01 | $25,182.57 | $25,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $6,791.98 / $11,755.35
| Facility | | $319.00 | $6,791.98 | $11,755.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,657.22 / $6,791.98 / $11,337.38
| Professional | | $3,657.22 | $6,791.98 | $11,337.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,440.91 / $5,160.00 / $9,473.73
| Professional | | $4,440.91 | $5,160.00 | $9,473.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $7,335.34 / $18,808.58
| Facility | | $597.00 | $7,335.34 | $18,808.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,395.99 / $5,694.81 / $12,016.58
| Professional | | $3,395.99 | $5,694.81 | $12,016.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,702.14 / $4,702.14 / $5,224.60
| Facility | | $4,702.14 | $4,702.14 | $5,224.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.33 / $3,134.76 / $7,918.30
| Professional | | $2,194.33 | $3,134.76 | $7,918.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,224.60 / $6,008.16 / $6,008.16
| Facility | | $5,224.60 | $6,008.16 | $6,008.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,440.91 / $5,224.60 / $6,279.53
| Professional | | $4,440.91 | $5,224.60 | $6,279.53 |