- 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
- $1,670.15 / $1,670.15 / $9,501.09
| Professional | | $1,670.15 | $1,670.15 | $9,501.09 |
- 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
- $1,602.80 / $2,732.05 / $3,642.73
| Professional | | $1,602.80 | $2,732.05 | $3,642.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,135.00 / $4,034.18 / $5,487.98
| Professional | | $3,135.00 | $4,034.18 | $5,487.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,670.15 / $2,922.76 / $7,441.00
| Facility | | $1,670.15 | $2,922.76 | $7,441.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,227.54 / $3,684.00 / $5,562.33
| Professional | | $2,227.54 | $3,684.00 | $5,562.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,369.31 / $4,150.78 / $5,581.23
| Facility | | $2,369.31 | $4,150.78 | $5,581.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,107.29 / $3,943.94 / $5,487.98
| Professional | | $3,107.29 | $3,943.94 | $5,487.98 |
- 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
- $2,227.54 / $3,803.95 / $4,797.77
| Professional | | $2,227.54 | $3,803.95 | $4,797.77 |