- 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
- $880.35 / $901.74 / $1,630.74
| Professional | | $880.35 | $901.74 | $1,630.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.25 / $1,036.25 / $1,036.25
| Professional | | $1,036.25 | $1,036.25 | $1,036.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,218.81 / $10,465.26 / $18,365.84
| Facility | | $7,218.81 | $10,465.26 | $18,365.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $842.92 / $1,436.81 / $1,915.76
| Professional | | $842.92 | $1,436.81 | $1,915.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.00 / $2,145.53 / $3,036.72
| Professional | | $1,192.00 | $2,145.53 | $3,036.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.35 / $1,496.60 / $2,152.84
| Facility | | $880.35 | $1,496.60 | $2,152.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.80 / $2,050.44 / $7,845.00
| Professional | | $1,368.80 | $2,050.44 | $7,845.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,556.00 / $2,145.53 / $2,908.82
| Facility | | $1,556.00 | $2,145.53 | $2,908.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.77 / $2,145.53 / $2,908.82
| Professional | | $1,467.77 | $2,145.53 | $2,908.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,253.20 / $2,550.30
| Professional | | $7.00 | $1,253.20 | $2,550.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.80 / $2,116.36 / $2,555.08
| Professional | | $1,368.80 | $2,116.36 | $2,555.08 |