- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,420.87 / $2,482.71 / $25,463.70
| Facility | | $1,420.87 | $2,482.71 | $25,463.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,093.02 / $14,474.60 / $25,463.70
| Professional | | $1,093.02 | $14,474.60 | $25,463.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,492.31 / $20,602.63 / $30,511.05
| Facility | | $9,492.31 | $20,602.63 | $30,511.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.43 / $3,617.96 / $21,939.66
| Professional | | $896.43 | $3,617.96 | $21,939.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.86 / $1,426.41 / $23,939.18
| Professional | | $1,088.86 | $1,426.41 | $23,939.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.67 / $13,934.25 / $26,882.57
| Professional | | $912.67 | $13,934.25 | $26,882.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.20 / $912.67 / $13,537.38
| Professional | | $785.20 | $912.67 | $13,537.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $15,307.65
| Professional | | $32.34 | $32.34 | $15,307.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,920.28 / $42,116.49 / $62,628.71
| Facility | | $26,920.28 | $42,116.49 | $62,628.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,146.73 / $21,039.60 / $33,501.44
| Professional | | $14,146.73 | $21,039.60 | $33,501.44 |