- 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
- $757.58 / $757.58 / $4,337.33
| Professional | | $757.58 | $757.58 | $4,337.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,952.65 / $9,144.62 / $17,688.66
| Facility | | $6,952.65 | $9,144.62 | $17,688.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.85 / $1,249.17 / $1,665.56
| Professional | | $732.85 | $1,249.17 | $1,665.56 |
- 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
- $1,252.00 / $1,821.55 / $2,435.65
| Professional | | $1,252.00 | $1,821.55 | $2,435.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.58 / $1,325.77 / $8,816.00
| Facility | | $757.58 | $1,325.77 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.01 / $1,668.05 / $2,271.42
| Professional | | $1,001.01 | $1,668.05 | $2,271.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,897.86 / $6,616.19
| Facility | | $1,285.00 | $1,897.86 | $6,616.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.07 / $1,790.80 / $2,435.65
| Professional | | $1,379.07 | $1,790.80 | $2,435.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.01 / $1,655.52 / $2,156.03
| Professional | | $1,001.01 | $1,655.52 | $2,156.03 |