- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.26 / $811.26 / $4,498.33
| Professional | | $811.26 | $811.26 | $4,498.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,306.43 / $5,664.13 / $10,956.25
| Facility | | $4,306.43 | $5,664.13 | $10,956.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.38 / $1,325.06 / $1,766.76
| Professional | | $777.38 | $1,325.06 | $1,766.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,664.80 / $6,664.80 / $6,664.80
| Facility | | $6,664.80 | $6,664.80 | $6,664.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.00 / $1,915.55 / $2,493.12
| Professional | | $1,368.00 | $1,915.55 | $2,493.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.26 / $1,460.27 / $8,816.00
| Facility | | $811.26 | $1,460.27 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.52 / $1,678.03 / $2,353.65
| Professional | | $1,028.52 | $1,678.03 | $2,353.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,026.64 / $8,644.09
| Facility | | $1,285.00 | $2,026.64 | $8,644.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,378.96 / $1,816.56 / $2,435.46
| Professional | | $1,378.96 | $1,816.56 | $2,435.46 |
- 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
- $1,028.52 / $1,678.03 / $2,215.28
| Professional | | $1,028.52 | $1,678.03 | $2,215.28 |