- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.31 / $5,463.36 / $13,841.56
| Facility | | $2,318.31 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.42 / $1,337.42 / $1,705.98
| Professional | | $1,337.42 | $1,337.42 | $1,705.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,889.38 / $7,684.16 / $14,983.55
| Facility | | $5,889.38 | $7,684.16 | $14,983.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.42 / $2,327.42 / $3,103.23
| Professional | | $1,365.42 | $2,327.42 | $3,103.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,055.09 / $17,055.09 / $17,055.09
| Facility | | $17,055.09 | $17,055.09 | $17,055.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,699.88 / $2,124.84 / $3,322.42
| Professional | | $1,699.88 | $2,124.84 | $3,322.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,337.42 / $3,592.13 / $102,618.25
| Facility | | $1,337.42 | $3,592.13 | $102,618.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,032.19 / $2,912.80 / $4,255.93
| Professional | | $2,032.19 | $2,912.80 | $4,255.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,178.40 / $3,322.42 / $27,783.00
| Facility | | $2,178.40 | $3,322.42 | $27,783.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,178.40 / $2,714.71 / $3,622.09
| Professional | | $2,178.40 | $2,714.71 | $3,622.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,221.00 / $14,143.00 / $40,166.00
| Facility | | $11,221.00 | $14,143.00 | $40,166.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,155.46 / $3,007.63 / $4,168.60
| Professional | | $2,155.46 | $3,007.63 | $4,168.60 |