- 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
- $1,697.06 / $1,757.79 / $9,718.48
| Professional | | $1,697.06 | $1,757.79 | $9,718.48 |
- 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
- $1,705.30 / $2,906.77 / $3,875.69
| Professional | | $1,705.30 | $2,906.77 | $3,875.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,781.00 / $4,311.54 / $5,789.85
| Professional | | $2,781.00 | $4,311.54 | $5,789.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,757.79 / $3,076.13 / $8,220.00
| Facility | | $1,757.79 | $3,076.13 | $8,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,350.06 / $3,660.65 / $5,340.66
| Professional | | $2,350.06 | $3,660.65 | $5,340.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.06 / $4,426.71 / $6,405.07
| Facility | | $2,290.06 | $4,426.71 | $6,405.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,967.92 / $4,220.58 / $5,789.85
| Professional | | $2,967.92 | $4,220.58 | $5,789.85 |
- 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
- $2,350.06 / $3,963.79 / $5,061.67
| Professional | | $2,350.06 | $3,963.79 | $5,061.67 |