- 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
- $627.74 / $687.13 / $3,652.79
| Professional | | $627.74 | $687.13 | $3,652.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,860.00 / $10,338.04 / $19,997.13
| Facility | | $7,860.00 | $10,338.04 | $19,997.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.94 / $1,135.10 / $1,513.50
| Professional | | $665.94 | $1,135.10 | $1,513.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,554.92 / $7,554.92 / $7,554.92
| Facility | | $7,554.92 | $7,554.92 | $7,554.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,130.00 / $1,655.95 / $2,217.17
| Professional | | $1,130.00 | $1,655.95 | $2,217.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.13 / $1,202.48 / $8,816.00
| Facility | | $687.13 | $1,202.48 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.23 / $1,502.08 / $2,062.03
| Professional | | $908.23 | $1,502.08 | $2,062.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,724.60 / $8,108.94
| Facility | | $1,089.00 | $1,724.60 | $8,108.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.00 / $1,519.10 / $2,217.17
| Professional | | $1,246.00 | $1,519.10 | $2,217.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.09 / $1,370.70 / $10,492.22
| Professional | | $752.09 | $1,370.70 | $10,492.22 |
- 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
- $908.23 / $1,529.09 / $1,956.19
| Professional | | $908.23 | $1,529.09 | $1,956.19 |