- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,477.27 / $19,276.96
| Facility | | $4,083.97 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.65 / $514.65 / $2,931.93
| Professional | | $514.65 | $514.65 | $2,931.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.88 / $612.88 / $612.88
| Professional | | $612.88 | $612.88 | $612.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,094.34 / $5,385.17 / $10,416.66
| Facility | | $4,094.34 | $5,385.17 | $10,416.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.66 / $849.98 / $1,133.30
| Professional | | $498.66 | $849.98 | $1,133.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.15 / $1,258.35 / $1,646.69
| Professional | | $1,039.15 | $1,258.35 | $1,646.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.65 / $900.64 / $5,405.32
| Facility | | $514.65 | $900.64 | $5,405.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.87 / $1,127.56 / $1,588.00
| Professional | | $674.87 | $1,127.56 | $1,588.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.15 / $1,387.59 / $2,961.89
| Facility | | $1,039.15 | $1,387.59 | $2,961.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.35 / $1,258.35 / $1,646.69
| Professional | | $932.35 | $1,258.35 | $1,646.69 |
- 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
- $674.87 / $1,127.56 / $1,453.56
| Professional | | $674.87 | $1,127.56 | $1,453.56 |