- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,035.10 / $16,543.90 / $21,921.40
| Facility | | $5,035.10 | $16,543.90 | $21,921.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,729.39 / $5,035.10 / $6,473.70
| Professional | | $4,729.39 | $5,035.10 | $6,473.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,314.91 / $8,225.89 / $22,521.28
| Facility | | $5,314.91 | $8,225.89 | $22,521.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,315.80 / $7,193.00 / $28,524.78
| Professional | | $4,315.80 | $7,193.00 | $28,524.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,193.00 / $10,285.99 / $19,291.63
| Facility | | $7,193.00 | $10,285.99 | $19,291.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,761.42 / $6,761.42 / $6,761.42
| Professional | | $6,761.42 | $6,761.42 | $6,761.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,486.10 / $5,143.00 / $16,364.08
| Facility | | $4,486.10 | $5,143.00 | $16,364.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,815.81 / $6,905.18 / $14,034.12
| Professional | | $3,815.81 | $6,905.18 | $14,034.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $5,733.00 / $39,575.89
| Facility | | $83.43 | $5,733.00 | $39,575.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,379.06 / $10,379.06 / $12,210.66
| Professional | | $10,379.06 | $10,379.06 | $12,210.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,193.00 / $7,193.00 / $14,386.00
| Professional | | $7,193.00 | $7,193.00 | $14,386.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,515.82 / $34,166.75 / $34,166.75
| Facility | | $12,515.82 | $34,166.75 | $34,166.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,315.80 / $4,315.80 / $35,821.14
| Professional | | $4,315.80 | $4,315.80 | $35,821.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,315.80 / $4,315.80 / $12,587.75
| Professional | | $4,315.80 | $4,315.80 | $12,587.75 |