- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,960.00 / $11,611.47
| Facility | | $4,964.00 | $6,960.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.10 / $2,760.56 / $9,341.40
| Professional | | $477.10 | $2,760.56 | $9,341.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.29 / $1,356.61 / $15,004.49
| Professional | | $1,085.29 | $1,356.61 | $15,004.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.94 / $6,578.51 / $11,223.26
| Professional | | $639.94 | $6,578.51 | $11,223.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.15 / $12,887.71 / $40,166.00
| Facility | | $1,085.15 | $12,887.71 | $40,166.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,352.40 / $14,171.33 / $23,401.93
| Professional | | $1,352.40 | $14,171.33 | $23,401.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.27 / $14,879.94 / $23,536.49
| Facility | | $1,196.27 | $14,879.94 | $23,536.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.15 / $11,035.58 / $16,849.04
| Professional | | $1,085.15 | $11,035.58 | $16,849.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,855.00 / $16,742.00 / $21,923.00
| Facility | | $12,855.00 | $16,742.00 | $21,923.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,148.69 / $12,630.03 / $19,718.46
| Professional | | $7,148.69 | $12,630.03 | $19,718.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $994.90 / $1,170.40 / $11,903.00
| Professional | | $994.90 | $1,170.40 | $11,903.00 |