- 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
- $1,301.79 / $2,150.65 / $7,041.77
| Professional | | $1,301.79 | $2,150.65 | $7,041.77 |
- 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
- $1,250.19 / $2,131.00 / $2,841.32
| Professional | | $1,250.19 | $2,131.00 | $2,841.32 |
- 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
- $2,713.86 / $3,177.17 / $3,971.46
| Professional | | $2,713.86 | $3,177.17 | $3,971.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.34 / $2,642.15 / $8,816.00
| Facility | | $1,308.34 | $2,642.15 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,759.05 / $2,624.52 / $3,514.67
| Professional | | $1,759.05 | $2,624.52 | $3,514.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.81 / $2,856.67 / $3,721.87
| Facility | | $1,474.81 | $2,856.67 | $3,721.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,911.36 / $2,713.86 / $3,721.87
| Professional | | $1,911.36 | $2,713.86 | $3,721.87 |
- 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
- $1,882.86 / $2,903.80 / $3,419.68
| Professional | | $1,882.86 | $2,903.80 | $3,419.68 |