- 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
- $1,421.81 / $1,592.09 / $8,501.54
| Professional | | $1,421.81 | $1,592.09 | $8,501.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,086.90 / $11,951.75 / $23,118.55
| Facility | | $9,086.90 | $11,951.75 | $23,118.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,523.63 / $2,595.38 / $3,462.80
| Professional | | $1,523.63 | $2,595.38 | $3,462.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,459.92 / $3,878.36 / $5,243.38
| Professional | | $2,459.92 | $3,878.36 | $5,243.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,592.09 / $2,786.16 / $7,441.00
| Facility | | $1,592.09 | $2,786.16 | $7,441.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,147.98 / $3,246.26 / $4,837.47
| Professional | | $2,147.98 | $3,246.26 | $4,837.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.36 / $3,588.14 / $5,243.38
| Facility | | $1,981.36 | $3,588.14 | $5,243.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,567.85 / $3,364.88 / $5,243.38
| Professional | | $2,567.85 | $3,364.88 | $5,243.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,147.98 / $3,552.45 / $4,358.77
| Professional | | $2,147.98 | $3,552.45 | $4,358.77 |