- 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
- $671.98 / $671.98 / $3,852.43
| Professional | | $671.98 | $671.98 | $3,852.43 |
- 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
- $650.41 / $1,108.67 / $1,478.22
| Professional | | $650.41 | $1,108.67 | $1,478.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.00 / $1,621.29 / $2,173.55
| Professional | | $1,112.00 | $1,621.29 | $2,173.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.98 / $1,175.97 / $7,934.00
| Facility | | $671.98 | $1,175.97 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.34 / $1,470.84 / $2,017.85
| Professional | | $889.34 | $1,470.84 | $2,017.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,684.38 / $6,616.19
| Facility | | $1,089.00 | $1,684.38 | $6,616.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.66 / $1,545.01 / $2,173.55
| Professional | | $1,230.66 | $1,545.01 | $2,173.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.74 / $1,275.85 / $1,476.22
| Professional | | $731.74 | $1,275.85 | $1,476.22 |
- 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
- $889.34 / $1,518.72 / $1,915.51
| Professional | | $889.34 | $1,518.72 | $1,915.51 |