- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,380.34 / $8,023.32 / $14,482.58
| Facility | | $3,380.34 | $8,023.32 | $14,482.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.81 / $737.12 / $3,613.30
| Professional | | $223.81 | $737.12 | $3,613.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.37 / $446.37 / $3,618.90
| Professional | | $446.37 | $446.37 | $3,618.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,779.83 / $7,833.15 / $14,704.82
| Facility | | $5,779.83 | $7,833.15 | $14,704.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.43 / $3,165.36 / $4,330.52
| Professional | | $1,905.43 | $3,165.36 | $4,330.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.79 / $3,912.88 / $5,829.62
| Professional | | $536.79 | $3,912.88 | $5,829.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.36 / $2,986.58 / $6,350.00
| Facility | | $285.36 | $2,986.58 | $6,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,406.98 / $4,364.02 / $15,390.40
| Professional | | $2,406.98 | $4,364.02 | $15,390.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.25 / $3,869.81 / $5,214.00
| Facility | | $570.25 | $3,869.81 | $5,214.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.66 / $3,246.59 / $5,214.00
| Professional | | $535.66 | $3,246.59 | $5,214.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $581.40 / $6,127.60
| Professional | | $4.00 | $581.40 | $6,127.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,655.59 / $4,249.43 / $5,037.35
| Professional | | $2,655.59 | $4,249.43 | $5,037.35 |