- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.53 / $515.53 / $515.53
| Professional | | $515.53 | $515.53 | $515.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,093.16 / $10,968.31 / $20,590.32
| Facility | | $8,093.16 | $10,968.31 | $20,590.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.91 / $838.42 / $3,635.52
| Professional | | $368.91 | $838.42 | $3,635.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.54 / $1,281.08 / $2,465.32
| Professional | | $740.54 | $1,281.08 | $2,465.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.53 / $902.18 / $6,451.00
| Facility | | $515.53 | $902.18 | $6,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.61 / $3,538.32 / $7,018.38
| Professional | | $1,331.61 | $3,538.32 | $7,018.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.54 / $1,225.33 / $2,465.32
| Facility | | $740.54 | $1,225.33 | $2,465.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.54 / $1,281.08 / $2,711.08
| Professional | | $740.54 | $1,281.08 | $2,711.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.61 / $3,927.54 / $4,339.75
| Professional | | $1,331.61 | $3,927.54 | $4,339.75 |