- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $11,611.47 / $24,068.03
| Facility | | $4,241.22 | $11,611.47 | $24,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.75 / $1,033.00 / $5,558.23
| Professional | | $961.75 | $1,033.00 | $5,558.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,349.44 / $9,666.52 / $18,698.16
| Facility | | $7,349.44 | $9,666.52 | $18,698.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.72 / $1,702.36 / $2,269.82
| Professional | | $998.72 | $1,702.36 | $2,269.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,767.00 / $2,507.73 / $3,361.95
| Professional | | $1,767.00 | $2,507.73 | $3,361.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.00 / $1,807.75 / $8,816.00
| Facility | | $1,033.00 | $1,807.75 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,381.22 / $2,284.33 / $3,124.18
| Professional | | $1,381.22 | $2,284.33 | $3,124.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,932.00 / $2,625.44 / $6,616.19
| Facility | | $1,932.00 | $2,625.44 | $6,616.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,903.54 / $2,345.51 / $3,361.95
| Professional | | $1,903.54 | $2,345.51 | $3,361.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.16 / $1,919.97 / $2,258.94
| Professional | | $1,101.16 | $1,919.97 | $2,258.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $8,816.00 / $10,575.11
| Facility | | $6,178.00 | $8,816.00 | $10,575.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.70 / $2,307.71 / $2,974.94
| Professional | | $1,344.70 | $2,307.71 | $2,974.94 |