- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,169.31 / $5,773.48 / $7,650.12
| Facility | | $2,169.31 | $5,773.48 | $7,650.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,033.27 / $2,169.31 / $3,279.17
| Professional | | $2,033.27 | $2,169.31 | $3,279.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,289.73 / $3,536.50 / $7,859.47
| Facility | | $2,289.73 | $3,536.50 | $7,859.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.13 / $2,635.72 / $9,954.56
| Professional | | $1,506.13 | $2,635.72 | $9,954.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,925.78 / $7,043.87 / $12,314.45
| Facility | | $4,925.78 | $7,043.87 | $12,314.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,851.10 / $2,851.10 / $2,851.10
| Professional | | $2,851.10 | $2,851.10 | $2,851.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,957.97 / $2,239.13 / $5,710.74
| Facility | | $1,957.97 | $2,239.13 | $5,710.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.22 / $2,648.48 / $12,445.95
| Professional | | $1,506.22 | $2,648.48 | $12,445.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $5,585.00 / $17,050.86
| Facility | | $83.43 | $5,585.00 | $17,050.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,621.95 / $3,621.95 / $4,261.12
| Professional | | $3,621.95 | $3,621.95 | $4,261.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,510.21 / $8,162.56
| Professional | | $2,510.21 | $2,510.21 | $8,162.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,367.77 / $11,923.50 / $11,923.50
| Facility | | $4,367.77 | $11,923.50 | $11,923.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.13 / $1,859.41 / $12,551.05
| Professional | | $1,506.13 | $1,859.41 | $12,551.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.13 / $1,859.41 / $5,188.10
| Professional | | $1,506.13 | $1,859.41 | $5,188.10 |