- 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
- $1,083.69 / $1,083.69 / $6,078.59
| Professional | | $1,083.69 | $1,083.69 | $6,078.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,306.43 / $5,664.13 / $10,956.25
| Facility | | $4,306.43 | $5,664.13 | $10,956.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.89 / $1,772.55 / $2,363.40
| Professional | | $1,039.89 | $1,772.55 | $2,363.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,859.00 / $2,564.88 / $3,335.84
| Professional | | $1,859.00 | $2,564.88 | $3,335.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.69 / $1,896.46 / $5,405.32
| Facility | | $1,083.69 | $1,896.46 | $5,405.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,395.91 / $2,298.96 / $3,181.86
| Professional | | $1,395.91 | $2,298.96 | $3,181.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,312.43 / $2,597.51 / $3,335.84
| Facility | | $1,312.43 | $2,597.51 | $3,335.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,888.74 / $2,468.67 / $3,335.84
| Professional | | $1,888.74 | $2,468.67 | $3,335.84 |
- 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
- $1,395.91 / $2,298.96 / $2,995.49
| Professional | | $1,395.91 | $2,298.96 | $2,995.49 |