- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,452.42 / $10,977.72 / $24,068.03
| Facility | | $2,452.42 | $10,977.72 | $24,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.25 / $2,452.42 / $4,159.31
| Professional | | $624.25 | $2,452.42 | $4,159.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,086.90 / $11,951.75 / $23,118.55
| Facility | | $9,086.90 | $11,951.75 | $23,118.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.12 / $1,498.00 / $4,881.14
| Professional | | $659.12 | $1,498.00 | $4,881.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,546.46 / $5,546.46 / $5,546.46
| Facility | | $5,546.46 | $5,546.46 | $5,546.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,306.61 / $4,732.00 / $7,505.65
| Professional | | $1,306.61 | $4,732.00 | $7,505.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.13 / $2,452.42 / $6,631.08
| Facility | | $741.13 | $2,452.42 | $6,631.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,468.86 / $5,795.23 / $9,616.04
| Professional | | $3,468.86 | $5,795.23 | $9,616.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,696.01 / $5,544.36 / $7,395.28
| Facility | | $1,696.01 | $5,544.36 | $7,395.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.53 / $4,840.75 / $7,456.32
| Professional | | $1,482.53 | $4,840.75 | $7,456.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,356.00 / $7,772.00
| Facility | | $3,711.00 | $5,356.00 | $7,772.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,468.86 / $5,336.70 / $7,471.38
| Professional | | $3,468.86 | $5,336.70 | $7,471.38 |