- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,915.56 / $25,184.28
| Facility | | $4,241.22 | $10,915.56 | $25,184.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.77 / $750.77 / $4,312.83
| Professional | | $750.77 | $750.77 | $4,312.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,999.34 / $17,097.68 / $33,072.44
| Facility | | $12,999.34 | $17,097.68 | $33,072.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.02 / $1,237.55 / $1,650.06
| Professional | | $726.02 | $1,237.55 | $1,650.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,949.89 / $9,949.89 / $9,949.89
| Facility | | $9,949.89 | $9,949.89 | $9,949.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,169.00 / $1,818.14 / $2,437.44
| Professional | | $1,169.00 | $1,818.14 | $2,437.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.77 / $1,313.85 / $8,816.00
| Facility | | $750.77 | $1,313.85 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.37 / $1,647.85 / $2,258.76
| Professional | | $996.37 | $1,647.85 | $2,258.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $1,880.19 / $12,675.86
| Facility | | $1,392.00 | $1,880.19 | $12,675.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,302.00 / $1,685.55 / $2,437.44
| Professional | | $1,302.00 | $1,685.55 | $2,437.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.71 / $1,494.40 / $13,669.06
| Professional | | $812.71 | $1,494.40 | $13,669.06 |
- 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
- $996.37 / $1,678.92 / $2,146.03
| Professional | | $996.37 | $1,678.92 | $2,146.03 |