- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,549.93 / $18,197.01
| Facility | | $5,370.32 | $9,549.93 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,737.80 / $7,244.36
| Professional | | $1,412.54 | $1,737.80 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,128.31 / $15,848.93
| Facility | | $6,165.95 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,398.83 / $3,467.37
| Professional | | $1,380.38 | $2,398.83 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,467.37 / $4,570.88
| Professional | | $1,548.82 | $3,467.37 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,818.38 / $9,772.37
| Facility | | $1,548.82 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,090.30 / $11,481.54
| Professional | | $1,949.84 | $3,090.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,467.37 / $4,897.79
| Professional | | $3,388.44 | $3,467.37 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Professional | | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $2,041.74 / $4,168.69
| Professional | | $5.01 | $2,041.74 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,413.10 / $9,120.11
| Facility | | $6,309.57 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,884.03 / $3,981.07
| Professional | | $1,995.26 | $2,884.03 | $3,981.07 |