- 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
- $2,008.88 / $2,008.88 / $10,830.89
| Professional | | $2,008.88 | $2,008.88 | $10,830.89 |
- 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
- $1,926.46 / $3,283.73 / $4,378.31
| Professional | | $1,926.46 | $3,283.73 | $4,378.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,383.00 / $4,892.75 / $6,613.36
| Professional | | $3,383.00 | $4,892.75 | $6,613.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,008.88 / $3,515.54 / $8,757.16
| Facility | | $2,008.88 | $3,515.54 | $8,757.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,714.09 / $4,158.85 / $6,129.23
| Professional | | $2,714.09 | $4,158.85 | $6,129.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,521.98 / $4,852.51 / $6,829.52
| Facility | | $2,521.98 | $4,852.51 | $6,829.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,517.00 / $4,426.10 / $6,613.36
| Professional | | $3,517.00 | $4,426.10 | $6,613.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,210.00 / $7,221.00 / $8,632.00
| Facility | | $6,210.00 | $7,221.00 | $8,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,714.09 / $4,634.83 / $5,507.51
| Professional | | $2,714.09 | $4,634.83 | $5,507.51 |