- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $8,477.27 / $19,276.96
| Facility | | $4,382.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.23 / $1,265.23 / $1,265.23
| Professional | | $1,265.23 | $1,265.23 | $1,265.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,725.11 / $8,845.35 / $17,109.75
| Facility | | $6,725.11 | $8,845.35 | $17,109.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.09 / $418.38 / $3,770.84
| Professional | | $184.09 | $418.38 | $3,770.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,527.94 / $3,141.53 / $3,329.29
| Professional | | $2,527.94 | $3,141.53 | $3,329.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,265.23 / $2,214.15 / $8,816.00
| Facility | | $1,265.23 | $2,214.15 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,320.55 / $3,480.83 / $5,264.42
| Professional | | $2,320.55 | $3,480.83 | $5,264.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,835.56 / $3,187.79 / $4,250.38
| Facility | | $1,835.56 | $3,187.79 | $4,250.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,527.94 / $2,875.15 / $4,621.67
| Professional | | $2,527.94 | $2,875.15 | $4,621.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,320.55 / $3,480.83 / $5,145.82
| Professional | | $2,320.55 | $3,480.83 | $5,145.82 |