- 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
- $1,272.25 / $1,272.25 / $7,233.55
| Professional | | $1,272.25 | $1,272.25 | $7,233.55 |
- 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
- $1,219.53 / $2,078.73 / $2,771.65
| Professional | | $1,219.53 | $2,078.73 | $2,771.65 |
- 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
- $2,151.00 / $3,004.95 / $4,000.02
| Professional | | $2,151.00 | $3,004.95 | $4,000.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.25 / $2,226.44 / $8,816.00
| Facility | | $1,272.25 | $2,226.44 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,661.95 / $2,769.42 / $3,786.78
| Professional | | $1,661.95 | $2,769.42 | $3,786.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.79 / $3,246.61 / $6,616.19
| Facility | | $1,479.79 | $3,246.61 | $6,616.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,264.81 / $2,797.25 / $4,000.02
| Professional | | $2,264.81 | $2,797.25 | $4,000.02 |
- 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
- $1,661.95 / $2,769.42 / $3,579.58
| Professional | | $1,661.95 | $2,769.42 | $3,579.58 |