- 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
- $844.33 / $844.33 / $4,524.29
| Professional | | $844.33 | $844.33 | $4,524.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,522.03 / $5,947.70 / $11,504.78
| Facility | | $4,522.03 | $5,947.70 | $11,504.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.71 / $1,392.11 / $1,856.16
| Professional | | $816.71 | $1,392.11 | $1,856.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,463.00 / $2,053.64 / $2,753.17
| Professional | | $1,463.00 | $2,053.64 | $2,753.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.33 / $1,477.58 / $5,453.15
| Facility | | $844.33 | $1,477.58 | $5,453.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.84 / $1,860.33 / $2,547.92
| Professional | | $1,124.84 | $1,860.33 | $2,547.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,719.96 / $2,753.17
| Facility | | $1,257.44 | $1,719.96 | $2,753.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,558.84 / $1,958.13 / $2,753.17
| Professional | | $1,558.84 | $1,958.13 | $2,753.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.94 / $1,664.00 / $1,852.94
| Professional | | $910.94 | $1,664.00 | $1,852.94 |
- 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
- $1,124.84 / $1,886.23 / $2,422.76
| Professional | | $1,124.84 | $1,886.23 | $2,422.76 |