- 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
- $521.63 / $571.28 / $3,024.58
| Professional | | $521.63 | $571.28 | $3,024.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,358.48 / $1,358.48 / $1,358.48
| Professional | | $1,358.48 | $1,358.48 | $1,358.48 |
- 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
- $553.16 / $942.89 / $1,257.20
| Professional | | $553.16 | $942.89 | $1,257.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,002.31 / $3,002.31 / $3,002.31
| Facility | | $3,002.31 | $3,002.31 | $3,002.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.00 / $1,374.68 / $1,840.56
| Professional | | $932.00 | $1,374.68 | $1,840.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.28 / $999.74 / $8,163.00
| Facility | | $571.28 | $999.74 | $8,163.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.20 / $1,247.32 / $1,714.80
| Professional | | $754.20 | $1,247.32 | $1,714.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,432.55 / $3,222.48
| Facility | | $1,089.00 | $1,432.55 | $3,222.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,038.00 / $1,362.22 / $1,840.56
| Professional | | $1,038.00 | $1,362.22 | $1,840.56 |
- 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
- $754.20 / $1,247.32 / $1,624.42
| Professional | | $754.20 | $1,247.32 | $1,624.42 |