- 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
- $1,490.76 / $1,490.76 / $9,100.45
| Professional | | $1,490.76 | $1,490.76 | $9,100.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,195.75 / $12,094.93 / $23,395.49
| Facility | | $9,195.75 | $12,094.93 | $23,395.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.41 / $2,450.13 / $3,266.84
| Professional | | $1,437.41 | $2,450.13 | $3,266.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,420.00 / $3,627.49 / $4,975.31
| Professional | | $2,420.00 | $3,627.49 | $4,975.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.76 / $2,608.83 / $9,496.00
| Facility | | $1,490.76 | $2,608.83 | $9,496.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.36 / $3,468.70 / $4,661.31
| Professional | | $2,097.36 | $3,468.70 | $4,661.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,995.43 / $3,722.47 / $5,220.43
| Facility | | $2,995.43 | $3,722.47 | $5,220.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,995.43 / $3,938.34 / $5,220.43
| Professional | | $2,995.43 | $3,938.34 | $5,220.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.36 / $3,577.43 / $4,517.38
| Professional | | $2,097.36 | $3,577.43 | $4,517.38 |