- 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
- $1,256.65 / $2,076.42 / $6,786.30
| Professional | | $1,256.65 | $2,076.42 | $6,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,086.90 / $11,856.11 / $23,118.55
| Facility | | $9,086.90 | $11,856.11 | $23,118.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,206.71 / $2,056.88 / $2,742.52
| Professional | | $1,206.71 | $2,056.88 | $2,742.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,017.28 / $3,017.28 / $3,017.28
| Facility | | $3,017.28 | $3,017.28 | $3,017.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,619.48 / $3,067.32 / $3,834.15
| Professional | | $2,619.48 | $3,067.32 | $3,834.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,262.91 / $2,534.54 / $8,816.00
| Facility | | $1,262.91 | $2,534.54 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,694.20 / $2,538.28 / $3,387.41
| Professional | | $1,694.20 | $2,538.28 | $3,387.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,425.45 / $3,017.28 / $3,933.51
| Facility | | $1,425.45 | $3,017.28 | $3,933.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,847.38 / $2,619.48 / $3,592.17
| Professional | | $1,847.38 | $2,619.48 | $3,592.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,940.06 / $6,178.00 / $8,816.00
| Facility | | $2,940.06 | $6,178.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,923.22 / $2,803.14 / $3,307.32
| Professional | | $1,923.22 | $2,803.14 | $3,307.32 |