- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,005.00 / $10,563.53 / $20,928.72
| Facility | | $5,005.00 | $10,563.53 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.51 / $2,036.71 / $6,597.65
| Professional | | $1,190.51 | $2,036.71 | $6,597.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,833.84 / $6,306.95 / $12,298.09
| Facility | | $4,833.84 | $6,306.95 | $12,298.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.30 / $1,947.10 / $2,596.15
| Professional | | $1,142.30 | $1,947.10 | $2,596.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,380.56 / $2,380.56 / $2,380.56
| Facility | | $2,380.56 | $2,380.56 | $2,380.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,479.67 / $2,899.81 / $3,624.76
| Professional | | $2,479.67 | $2,899.81 | $3,624.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.74 / $2,425.34 / $8,816.00
| Facility | | $1,196.74 | $2,425.34 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,631.29 / $2,486.05 / $3,268.02
| Professional | | $1,631.29 | $2,486.05 | $3,268.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,358.68 / $2,706.78 / $3,540.27
| Facility | | $1,358.68 | $2,706.78 | $3,540.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,760.84 / $2,479.67 / $3,519.90
| Professional | | $1,760.84 | $2,479.67 | $3,519.90 |
- 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
- $1,750.73 / $2,719.93 / $3,268.02
| Professional | | $1,750.73 | $2,719.93 | $3,268.02 |