- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,397.00 / $8,877.70 / $10,647.00
| Facility | | $7,397.00 | $8,877.70 | $10,647.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,423.17 / $8,449.21 / $8,877.70
| Professional | | $6,423.17 | $8,449.21 | $8,877.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,247.64 / $35,749.05 / $68,785.35
| Facility | | $18,247.64 | $35,749.05 | $68,785.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,971.27 / $2,464.09 / $2,464.09
| Professional | | $1,971.27 | $2,464.09 | $2,464.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,029.24 / $42,585.19 / $102,444.44
| Facility | | $30,029.24 | $42,585.19 | $102,444.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,503.57 / $14,706.86 / $16,979.74
| Professional | | $13,503.57 | $14,706.86 | $16,979.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,411.61 / $38,933.08 / $80,664.91
| Facility | | $24,411.61 | $38,933.08 | $80,664.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,369.88 / $13,369.88 / $16,043.85
| Professional | | $13,369.88 | $13,369.88 | $16,043.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,527.00 / $15,003.31 / $43,296.38
| Facility | | $7,527.00 | $15,003.31 | $43,296.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.35 / $2,071.94 / $11,522.58
| Professional | | $1,008.35 | $2,071.94 | $11,522.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $11,496.00 / $21,528.00
| Facility | | $5,028.00 | $11,496.00 | $21,528.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.28 / $2,407.02 / $15,137.53
| Professional | | $1,120.28 | $2,407.02 | $15,137.53 |