- 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
- $1,923.52 / $1,923.52 / $11,317.10
| Professional | | $1,923.52 | $1,923.52 | $11,317.10 |
- 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
- $1,866.59 / $3,181.69 / $4,242.27
| Professional | | $1,866.59 | $3,181.69 | $4,242.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,682.61 / $4,621.97 / $5,907.53
| Professional | | $2,682.61 | $4,621.97 | $5,907.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,923.52 / $3,366.16 / $8,220.00
| Facility | | $1,923.52 | $3,366.16 | $8,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,566.01 / $4,198.34 / $5,834.16
| Professional | | $2,566.01 | $4,198.34 | $5,834.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,323.89 / $4,395.01 / $6,999.51
| Facility | | $2,323.89 | $4,395.01 | $6,999.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,011.76 / $4,359.22 / $6,061.67
| Professional | | $3,011.76 | $4,359.22 | $6,061.67 |
- 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
- $2,566.01 / $4,243.78 / $5,526.78
| Professional | | $2,566.01 | $4,243.78 | $5,526.78 |