- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,771.71 / $8,477.27 / $20,928.72
| Facility | | $1,771.71 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,648.70 / $1,771.71 / $1,771.71
| Professional | | $1,648.70 | $1,771.71 | $1,771.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.86 / $908.77 / $3,624.86
| Professional | | $399.86 | $908.77 | $3,624.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,884.73 / $6,884.73 / $6,884.73
| Facility | | $6,884.73 | $6,884.73 | $6,884.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,672.61 / $2,227.88 / $4,185.70
| Professional | | $1,672.61 | $2,227.88 | $4,185.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,594.54 / $3,086.67 / $10,575.11
| Facility | | $1,594.54 | $3,086.67 | $10,575.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,134.08 / $2,040.17 / $4,551.79
| Professional | | $1,134.08 | $2,040.17 | $4,551.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,182.50 / $3,541.37 / $8,720.66
| Facility | | $2,182.50 | $3,541.37 | $8,720.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,714.43 / $2,195.48 / $4,160.35
| Professional | | $1,714.43 | $2,195.48 | $4,160.35 |
- 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
- $1,190.05 / $2,652.21 / $4,236.35
| Professional | | $1,190.05 | $2,652.21 | $4,236.35 |