- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.13 / $10,980.00 / $16,197.90
| Facility | | $3,137.13 | $10,980.00 | $16,197.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.80 / $3,137.13 / $24,903.40
| Professional | | $2,323.80 | $3,137.13 | $24,903.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $17,318.50 / $26,323.62
| Facility | | $8,639.91 | $17,318.50 | $26,323.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,020.94 / $3,020.94 / $3,020.94
| Professional | | $3,020.94 | $3,020.94 | $3,020.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,675.48 / $5,721.37 / $12,852.35
| Facility | | $3,675.48 | $5,721.37 | $12,852.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,783.73 / $3,573.39 / $6,725.85
| Professional | | $1,783.73 | $3,573.39 | $6,725.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,304.44 / $5,228.55 / $7,358.70
| Professional | | $2,304.44 | $5,228.55 | $7,358.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,292.05 / $10,980.00 / $15,995.50
| Facility | | $3,292.05 | $10,980.00 | $15,995.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,633.64 / $3,292.05 / $15,995.50
| Professional | | $2,633.64 | $3,292.05 | $15,995.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,732.04 / $5,809.50 / $7,746.00
| Professional | | $5,732.04 | $5,809.50 | $7,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,769.64 / $6,443.41 / $12,852.35
| Facility | | $3,769.64 | $6,443.41 | $12,852.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,783.73 / $3,589.04 / $6,751.53
| Professional | | $1,783.73 | $3,589.04 | $6,751.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.00 / $3,873.00 / $4,260.30
| Facility | | $3,873.00 | $3,873.00 | $4,260.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,873.00 / $3,873.00 / $4,260.30
| Professional | | $3,873.00 | $3,873.00 | $4,260.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,626.66 / $1,626.66 / $1,626.66
| Facility | | $1,626.66 | $1,626.66 | $1,626.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $2,323.80 / $5,422.20
| Professional | | $1,626.66 | $2,323.80 | $5,422.20 |