- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.50 / $10,506.16 / $21,899.37
| Facility | | $4,570.50 | $10,506.16 | $21,899.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,228.44 / $2,042.35 / $7,032.61
| Professional | | $1,228.44 | $2,042.35 | $7,032.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,065.60 / $6,609.33 / $12,887.71
| Facility | | $5,065.60 | $6,609.33 | $12,887.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.76 / $2,024.58 / $2,699.44
| Professional | | $1,187.76 | $2,024.58 | $2,699.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,026.02 / $3,026.02 / $3,782.53
| Professional | | $3,026.02 | $3,026.02 | $3,782.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.76 / $2,826.57 / $8,816.00
| Facility | | $1,236.76 | $2,826.57 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.71 / $2,719.79 / $3,642.35
| Professional | | $1,889.71 | $2,719.79 | $3,642.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.04 / $3,440.28 / $7,468.46
| Facility | | $1,582.04 | $3,440.28 | $7,468.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.00 / $2,764.86 / $3,498.49
| Professional | | $1,862.00 | $2,764.86 | $3,498.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,022.76 / $7,221.00 / $8,816.00
| Facility | | $4,022.76 | $7,221.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,897.53 / $2,795.41 / $3,173.06
| Professional | | $1,897.53 | $2,795.41 | $3,173.06 |