- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $11,100.08 / $24,068.03
| Facility | | $4,241.22 | $11,100.08 | $24,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.28 / $1,037.45 / $4,914.00
| Professional | | $924.28 | $1,037.45 | $4,914.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,295.69 / $2,295.69 / $2,295.69
| Professional | | $2,295.69 | $2,295.69 | $2,295.69 |
- 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
- $934.70 / $1,593.24 / $2,124.32
| Professional | | $934.70 | $1,593.24 | $2,124.32 |
- 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
- $1,795.00 / $2,332.01 / $3,126.34
| Professional | | $1,795.00 | $2,332.01 | $3,126.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.61 / $1,741.70 / $8,816.00
| Facility | | $967.61 | $1,741.70 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.99 / $2,138.62 / $2,924.49
| Professional | | $1,292.99 | $2,138.62 | $2,924.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,932.00 / $2,493.46 / $6,616.19
| Facility | | $1,932.00 | $2,493.46 | $6,616.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,770.14 / $2,266.02 / $3,126.34
| Professional | | $1,770.14 | $2,266.02 | $3,126.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.99 / $2,277.23 / $2,784.91
| Professional | | $1,292.99 | $2,277.23 | $2,784.91 |