- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $7,943.28 / $14,454.40
| Facility | | $1,621.81 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,000.00 / $4,897.79
| Professional | | $831.76 | $1,000.00 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,511.38 / $16,595.87
| Facility | | $6,456.54 | $8,511.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,380.38 / $1,995.26
| Professional | | $831.76 | $1,380.38 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,995.26 / $2,570.40
| Professional | | $977.24 | $1,995.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,445.44 / $8,912.51
| Facility | | $831.76 | $1,445.44 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,659.59 / $7,079.46
| Professional | | $954.99 | $1,659.59 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,041.74 / $2,818.38
| Professional | | $1,737.80 | $2,041.74 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,041.74 / $2,818.38
| Professional | | $1,949.84 | $2,041.74 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,413.10 / $9,120.11
| Facility | | $6,309.57 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,621.81 / $2,344.23
| Professional | | $954.99 | $1,621.81 | $2,344.23 |