- 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
- $1,196.94 / $1,196.94 / $6,295.82
| Professional | | $1,196.94 | $1,196.94 | $6,295.82 |
- 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
- $1,151.46 / $1,962.71 / $2,616.94
| Professional | | $1,151.46 | $1,962.71 | $2,616.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,853.00 / $2,743.36 / $3,677.35
| Professional | | $1,853.00 | $2,743.36 | $3,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.94 / $2,094.65 / $8,220.00
| Facility | | $1,196.94 | $2,094.65 | $8,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,462.37 / $2,418.54 / $3,296.38
| Professional | | $1,462.37 | $2,418.54 | $3,296.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,407.69 / $2,762.35 / $4,053.49
| Facility | | $1,407.69 | $2,762.35 | $4,053.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,055.83 / $2,531.55 / $3,630.94
| Professional | | $2,055.83 | $2,531.55 | $3,630.94 |
- 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
- $1,462.37 / $2,497.28 / $3,149.72
| Professional | | $1,462.37 | $2,497.28 | $3,149.72 |