- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $23,483.17
| Facility | | $4,241.22 | $10,431.19 | $23,483.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.15 / $1,563.15 / $9,158.96
| Professional | | $1,563.15 | $1,563.15 | $9,158.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.40 / $10,296.48 / $19,916.72
| Facility | | $7,828.40 | $10,296.48 | $19,916.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.55 / $2,586.73 / $3,448.98
| Professional | | $1,517.55 | $2,586.73 | $3,448.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,580.00 / $3,808.47 / $5,105.75
| Professional | | $2,580.00 | $3,808.47 | $5,105.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,563.15 / $2,735.51 / $8,220.00
| Facility | | $1,563.15 | $2,735.51 | $8,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,076.27 / $3,433.83 / $4,723.21
| Professional | | $2,076.27 | $3,433.83 | $4,723.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,018.08 / $3,922.62 / $5,678.23
| Facility | | $2,018.08 | $3,922.62 | $5,678.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,890.87 / $3,700.72 / $5,105.75
| Professional | | $2,890.87 | $3,700.72 | $5,105.75 |
- 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
- $2,076.27 / $3,546.47 / $4,471.96
| Professional | | $2,076.27 | $3,546.47 | $4,471.96 |