- 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
- $1,591.51 / $1,591.51 / $9,234.66
| Professional | | $1,591.51 | $1,591.51 | $9,234.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,349.44 / $9,666.52 / $18,698.16
| Facility | | $7,349.44 | $9,666.52 | $18,698.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,535.63 / $2,617.55 / $3,490.07
| Professional | | $1,535.63 | $2,617.55 | $3,490.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,748.51 / $3,900.95 / $5,258.70
| Professional | | $1,748.51 | $3,900.95 | $5,258.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.36 / $2,705.57 / $8,220.00
| Facility | | $1,432.36 | $2,705.57 | $8,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,824.00 / $3,382.48 / $4,838.68
| Professional | | $1,824.00 | $3,382.48 | $4,838.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.08 / $3,890.79 / $5,258.70
| Facility | | $2,047.08 | $3,890.79 | $5,258.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,836.59 / $3,539.72 / $5,258.70
| Professional | | $1,836.59 | $3,539.72 | $5,258.70 |
- 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
- $1,978.81 / $3,382.48 / $4,617.22
| Professional | | $1,978.81 | $3,382.48 | $4,617.22 |