- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $21,899.37
| Facility | | $4,241.22 | $10,431.19 | $21,899.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.65 / $1,134.41 / $1,134.41
| Professional | | $1,055.65 | $1,134.41 | $1,134.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,454.65 / $2,479.52 / $3,306.03
| Professional | | $1,454.65 | $2,479.52 | $3,306.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.25 / $1,680.49 / $2,987.37
| Professional | | $698.25 | $1,680.49 | $2,987.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,134.41 / $1,985.22 / $10,370.43
| Facility | | $1,134.41 | $1,985.22 | $10,370.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,946.67 / $3,144.62 / $4,327.60
| Professional | | $1,946.67 | $3,144.62 | $4,327.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.01 / $2,020.24 / $2,403.90
| Facility | | $1,623.01 | $2,020.24 | $2,403.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,623.01 / $1,848.01 / $2,669.43
| Professional | | $1,623.01 | $1,848.01 | $2,669.43 |
- 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
- $1,946.67 / $3,321.32 / $3,950.25
| Professional | | $1,946.67 | $3,321.32 | $3,950.25 |