- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,764.00 / $4,284.00 / $8,631.64
| Facility | | $1,764.00 | $4,284.00 | $8,631.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,523.14 / $2,249.28 / $4,955.22
| Professional | | $1,523.14 | $2,249.28 | $4,955.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,526.00 / $9,992.00 / $17,206.00
| Facility | | $7,526.00 | $9,992.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,594.88 / $17,010.84 / $20,924.30
| Facility | | $13,594.88 | $17,010.84 | $20,924.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,620.37 / $15,358.14 / $33,398.22
| Facility | | $8,620.37 | $15,358.14 | $33,398.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.90 / $100.00 / $17,058.50
| Facility | | $65.90 | $100.00 | $17,058.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Professional | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.75 / $1,985.06 / $2,179.62
| Professional | | $1,136.75 | $1,985.06 | $2,179.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,368.08 / $7,491.98 / $7,947.84
| Professional | | $2,368.08 | $7,491.98 | $7,947.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,242.27 / $10,642.01 / $11,205.68
| Facility | | $7,242.27 | $10,642.01 | $11,205.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,298.29 / $3,428.45 / $5,370.68
| Professional | | $3,298.29 | $3,428.45 | $5,370.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.00 / $10,316.00 / $19,562.00
| Facility | | $4,873.00 | $10,316.00 | $19,562.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.66 / $1,796.60 / $3,759.47
| Professional | | $1,144.66 | $1,796.60 | $3,759.47 |