- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $8,477.27 / $19,276.96
| Facility | | $4,241.22 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.60 / $1,622.10 / $5,370.08
| Professional | | $989.60 | $1,622.10 | $5,370.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,104.22 / $6,659.73 / $12,985.98
| Facility | | $5,104.22 | $6,659.73 | $12,985.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.50 / $1,625.29 / $2,167.05
| Professional | | $953.50 | $1,625.29 | $2,167.05 |
- 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
- $2,069.84 / $2,431.57 / $3,039.46
| Professional | | $2,069.84 | $2,431.57 | $3,039.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.24 / $1,938.60 / $8,816.00
| Facility | | $995.24 | $1,938.60 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,362.13 / $2,067.42 / $2,730.85
| Professional | | $1,362.13 | $2,067.42 | $2,730.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.55 / $2,454.03 / $3,123.31
| Facility | | $1,157.55 | $2,454.03 | $3,123.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,335.00 / $2,069.84 / $2,825.93
| Professional | | $1,335.00 | $2,069.84 | $2,825.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $6,178.00 / $8,632.00
| Facility | | $4,700.00 | $6,178.00 | $8,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,557.79 / $2,095.85 / $2,692.45
| Professional | | $1,557.79 | $2,095.85 | $2,692.45 |