- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $3,551.09 / $7,602.00
| Facility | | $2,258.00 | $3,551.09 | $7,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,504.70 / $1,866.41 / $3,023.58
| Professional | | $1,504.70 | $1,866.41 | $3,023.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,725.00 / $9,153.00 / $15,472.00
| Facility | | $4,725.00 | $9,153.00 | $15,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,562.58 / $2,229.09 / $3,809.18
| Professional | | $1,562.58 | $2,229.09 | $3,809.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,614.84 / $2,564.17 / $3,846.17
| Professional | | $1,614.84 | $2,564.17 | $3,846.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $27,543.68 / $28,224.16
| Facility | | $55.00 | $27,543.68 | $28,224.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,828.08 / $11,095.28 / $13,128.75
| Professional | | $10,828.08 | $11,095.28 | $13,128.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,650.02 / $2,548.31 / $3,863.69
| Professional | | $1,650.02 | $2,548.31 | $3,863.69 |