- 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
- $1,261.98 / $1,261.98 / $7,101.48
| Professional | | $1,261.98 | $1,261.98 | $7,101.48 |
- 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
- $1,213.80 / $2,068.98 / $2,758.65
| Professional | | $1,213.80 | $2,068.98 | $2,758.65 |
- 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
- $1,981.00 / $2,969.04 / $3,920.02
| Professional | | $1,981.00 | $2,969.04 | $3,920.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,237.30 / $2,208.46 / $5,405.32
| Facility | | $1,237.30 | $2,208.46 | $5,405.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,631.36 / $2,645.58 / $3,717.73
| Professional | | $1,631.36 | $2,645.58 | $3,717.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,543.76 / $2,920.46 / $3,920.02
| Facility | | $1,543.76 | $2,920.46 | $3,920.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.72 / $2,634.89 / $3,920.02
| Professional | | $2,000.72 | $2,634.89 | $3,920.02 |
- 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
- $1,631.36 / $2,447.04 / $3,310.40
| Professional | | $1,631.36 | $2,447.04 | $3,310.40 |