- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.66 / $1,032.66 / $1,032.66
| Professional | | $1,032.66 | $1,032.66 | $1,032.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,638.95 / $13,993.13 / $27,067.23
| Facility | | $10,638.95 | $13,993.13 | $27,067.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.26 / $1,573.76 / $2,098.34
| Professional | | $923.26 | $1,573.76 | $2,098.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.64 / $4,097.77 / $10,602.60
| Professional | | $1,947.64 | $4,097.77 | $10,602.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.66 / $1,807.16 / $9,284.10
| Facility | | $1,032.66 | $1,807.16 | $9,284.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,452.51 / $9,248.35 / $15,186.00
| Professional | | $2,452.51 | $9,248.35 | $15,186.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.31 / $3,558.56 / $10,867.67
| Facility | | $2,064.31 | $3,558.56 | $10,867.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,064.31 / $4,506.24 / $10,920.38
| Professional | | $2,064.31 | $4,506.24 | $10,920.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.19 / $8,135.36 / $13,434.18
| Professional | | $2,137.19 | $8,135.36 | $13,434.18 |