- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.83 / $1,056.83 / $6,091.69
| Professional | | $1,056.83 | $1,056.83 | $6,091.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,018.72 / $10,546.81 / $20,400.93
| Facility | | $8,018.72 | $10,546.81 | $20,400.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.34 / $1,740.92 / $2,321.23
| Professional | | $1,021.34 | $1,740.92 | $2,321.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,674.81 / $6,674.81 / $6,674.81
| Facility | | $6,674.81 | $6,674.81 | $6,674.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,128.37 / $2,573.07 / $3,449.53
| Professional | | $2,128.37 | $2,573.07 | $3,449.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.83 / $1,893.86 / $9,496.00
| Facility | | $1,056.83 | $1,893.86 | $9,496.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,410.46 / $2,380.38 / $3,191.22
| Professional | | $1,410.46 | $2,380.38 | $3,191.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.04 / $2,849.08 / $8,454.75
| Facility | | $1,348.04 | $2,849.08 | $8,454.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,953.13 / $2,582.96 / $3,449.53
| Professional | | $1,953.13 | $2,582.96 | $3,449.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $9,094.60 / $10,575.11
| Facility | | $6,777.00 | $9,094.60 | $10,575.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,410.46 / $2,149.54 / $3,037.92
| Professional | | $1,410.46 | $2,149.54 | $3,037.92 |