- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $8,477.27 / $21,899.37
| Facility | | $4,241.22 | $8,477.27 | $21,899.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.67 / $871.67 / $5,000.57
| Professional | | $871.67 | $871.67 | $5,000.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.82 / $1,438.32 / $1,917.77
| Professional | | $843.82 | $1,438.32 | $1,917.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,173.26 / $7,173.26 / $7,173.26
| Facility | | $7,173.26 | $7,173.26 | $7,173.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,653.00 / $2,104.91 / $2,821.93
| Professional | | $1,653.00 | $2,104.91 | $2,821.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.67 / $1,574.29 / $9,496.00
| Facility | | $871.67 | $1,574.29 | $9,496.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.40 / $1,936.00 / $2,618.92
| Professional | | $1,154.40 | $1,936.00 | $2,618.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $2,350.81 / $7,699.29
| Facility | | $1,392.00 | $2,350.81 | $7,699.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,597.77 / $2,082.80 / $2,821.93
| Professional | | $1,597.77 | $2,082.80 | $2,821.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.10 / $1,651.36 / $1,915.11
| Professional | | $947.10 | $1,651.36 | $1,915.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.40 / $1,943.21 / $2,486.40
| Professional | | $1,154.40 | $1,943.21 | $2,486.40 |