- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,711.10 / $8,907.90 / $11,803.40
| Facility | | $2,711.10 | $8,907.90 | $11,803.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,546.50 / $2,711.10 / $3,485.70
| Professional | | $2,546.50 | $2,711.10 | $3,485.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,526.56 / $10,772.49 / $14,150.78
| Facility | | $4,526.56 | $10,772.49 | $14,150.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.80 / $3,873.00 / $15,358.88
| Professional | | $2,323.80 | $3,873.00 | $15,358.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,281.76 / $8,982.92 / $15,704.40
| Facility | | $6,281.76 | $8,982.92 | $15,704.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,640.62 / $3,640.62 / $3,640.62
| Professional | | $3,640.62 | $3,640.62 | $3,640.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,542.62 / $2,769.20 / $8,811.08
| Facility | | $2,542.62 | $2,769.20 | $8,811.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,317.90 / $2,356.44 / $6,303.54
| Professional | | $2,317.90 | $2,356.44 | $6,303.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $5,585.00 / $21,309.25
| Facility | | $83.43 | $5,585.00 | $21,309.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,588.36 / $5,588.36 / $6,574.54
| Professional | | $5,588.36 | $5,588.36 | $6,574.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,873.00 / $3,873.00 / $10,805.67
| Professional | | $3,873.00 | $3,873.00 | $10,805.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,739.02 / $18,396.75 / $18,396.75
| Facility | | $6,739.02 | $18,396.75 | $18,396.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.80 / $2,323.80 / $19,287.54
| Professional | | $2,323.80 | $2,323.80 | $19,287.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.80 / $2,323.80 / $6,274.88
| Professional | | $2,323.80 | $2,323.80 | $6,274.88 |