- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.17 / $9,544.15 / $20,928.72
| Facility | | $1,174.17 | $9,544.15 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.96 / $581.21 / $1,431.77
| Professional | | $522.96 | $581.21 | $1,431.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.86 / $1,387.86 / $2,372.82
| Professional | | $1,387.86 | $1,387.86 | $2,372.82 |
- 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
- $563.04 / $959.75 / $1,279.68
| Professional | | $563.04 | $959.75 | $1,279.68 |
- 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
- $879.00 / $1,405.35 / $1,858.12
| Professional | | $879.00 | $1,405.35 | $1,858.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.21 / $1,017.12 / $8,163.00
| Facility | | $581.21 | $1,017.12 | $8,163.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.28 / $1,255.73 / $1,727.96
| Professional | | $759.28 | $1,255.73 | $1,727.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.00 / $1,553.00 / $2,961.89
| Facility | | $1,064.00 | $1,553.00 | $2,961.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.00 / $1,296.46 / $1,858.12
| Professional | | $974.00 | $1,296.46 | $1,858.12 |
- 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
- $759.28 / $1,280.33 / $1,635.37
| Professional | | $759.28 | $1,280.33 | $1,635.37 |