- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,417.02 / $11,611.47 / $24,068.03
| Facility | | $5,417.02 | $11,611.47 | $24,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,474.25 / $2,435.96 / $8,131.44
| Professional | | $1,474.25 | $2,435.96 | $8,131.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,833.84 / $6,306.95 / $12,298.09
| Facility | | $4,833.84 | $6,306.95 | $12,298.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,418.49 / $2,417.88 / $3,223.84
| Professional | | $1,418.49 | $2,417.88 | $3,223.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,380.56 / $2,380.56 / $2,380.56
| Facility | | $2,380.56 | $2,380.56 | $2,380.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,079.19 / $3,608.01 / $4,540.14
| Professional | | $3,079.19 | $3,608.01 | $4,540.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,483.12 / $3,147.92 / $8,816.00
| Facility | | $1,483.12 | $3,147.92 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,112.89 / $3,132.96 / $4,084.70
| Professional | | $2,112.89 | $3,132.96 | $4,084.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,932.00 / $2,973.84 / $4,207.07
| Facility | | $1,932.00 | $2,973.84 | $4,207.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,270.37 / $3,079.19 / $4,207.07
| Professional | | $2,270.37 | $3,079.19 | $4,207.07 |
- 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
- $2,185.79 / $3,234.96 / $4,080.13
| Professional | | $2,185.79 | $3,234.96 | $4,080.13 |