- 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
- $937.15 / $937.15 / $5,379.05
| Professional | | $937.15 | $937.15 | $5,379.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,921.80 / $10,419.34 / $20,154.36
| Facility | | $7,921.80 | $10,419.34 | $20,154.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $906.62 / $1,545.36 / $2,060.48
| Professional | | $906.62 | $1,545.36 | $2,060.48 |
- 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
- $1,362.00 / $2,264.06 / $3,052.37
| Professional | | $1,362.00 | $2,264.06 | $3,052.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.15 / $1,640.01 / $5,405.32
| Facility | | $937.15 | $1,640.01 | $5,405.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,203.33 / $2,135.25 / $2,893.09
| Professional | | $1,203.33 | $2,135.25 | $2,893.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.08 / $2,368.73 / $3,132.01
| Facility | | $1,250.08 | $2,368.73 | $3,132.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,491.00 / $2,152.30 / $3,052.37
| Professional | | $1,491.00 | $2,152.30 | $3,052.37 |
- 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
- $1,203.33 / $2,135.25 / $2,780.79
| Professional | | $1,203.33 | $2,135.25 | $2,780.79 |