- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,654.43 / $7,255.42 / $14,948.90
| Facility | | $4,654.43 | $7,255.42 | $14,948.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,833.06 / $4,490.16 / $4,928.22
| Professional | | $3,833.06 | $4,490.16 | $4,928.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,841.80 / $8,035.74 / $21,355.62
| Facility | | $1,841.80 | $8,035.74 | $21,355.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,406.68 / $7,666.12 / $9,692.16
| Facility | | $6,406.68 | $7,666.12 | $9,692.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $8,268.45 / $15,058.45
| Facility | | $97.00 | $8,268.45 | $15,058.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,285.48 / $3,285.48 / $4,654.43
| Professional | | $3,285.48 | $3,285.48 | $4,654.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,491.48 / $3,559.27 / $8,899.95
| Professional | | $2,491.48 | $3,559.27 | $8,899.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,702.85 / $1,833.62 / $4,517.53
| Professional | | $1,702.85 | $1,833.62 | $4,517.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,304.94 / $9,209.61 / $16,806.65
| Facility | | $4,304.94 | $9,209.61 | $16,806.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,570.96 / $6,669.58 / $7,990.91
| Professional | | $6,570.96 | $6,669.58 | $7,990.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,475.80 / $5,475.80 / $8,213.70
| Facility | | $5,475.80 | $5,475.80 | $8,213.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.84 / $3,285.48 / $6,297.17
| Professional | | $2,299.84 | $3,285.48 | $6,297.17 |