- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,477.27 / $19,276.96
| Facility | | $4,083.97 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.21 / $1,141.21 / $6,606.12
| Professional | | $1,141.21 | $1,141.21 | $6,606.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,810.78 / $8,958.04 / $17,327.75
| Facility | | $6,810.78 | $8,958.04 | $17,327.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.91 / $1,876.55 / $2,502.07
| Professional | | $1,100.91 | $1,876.55 | $2,502.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,634.43 / $4,634.43 / $4,634.43
| Facility | | $4,634.43 | $4,634.43 | $4,634.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,842.00 / $2,796.97 / $3,750.62
| Professional | | $1,842.00 | $2,796.97 | $3,750.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.21 / $2,045.15 / $8,632.00
| Facility | | $1,141.21 | $2,045.15 | $8,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,533.18 / $2,535.65 / $3,490.95
| Professional | | $1,533.18 | $2,535.65 | $3,490.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.98 / $2,867.60 / $7,145.13
| Facility | | $1,500.98 | $2,867.60 | $7,145.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,945.26 / $2,622.45 / $3,750.62
| Professional | | $1,945.26 | $2,622.45 | $3,750.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $8,152.95 / $9,480.17
| Facility | | $6,178.00 | $8,152.95 | $9,480.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,533.18 / $2,618.19 / $3,302.24
| Professional | | $1,533.18 | $2,618.19 | $3,302.24 |