- 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
- $1,073.95 / $1,145.42 / $6,183.64
| Professional | | $1,073.95 | $1,145.42 | $6,183.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,952.65 / $9,144.62 / $17,688.66
| Facility | | $6,952.65 | $9,144.62 | $17,688.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.70 / $1,905.16 / $2,540.21
| Professional | | $1,117.70 | $1,905.16 | $2,540.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,890.00 / $2,820.34 / $3,781.04
| Professional | | $1,890.00 | $2,820.34 | $3,781.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.42 / $2,004.49 / $8,220.00
| Facility | | $1,145.42 | $2,004.49 | $8,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,544.37 / $2,554.16 / $3,492.05
| Professional | | $1,544.37 | $2,554.16 | $3,492.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.90 / $2,829.58 / $3,957.56
| Facility | | $1,480.90 | $2,829.58 | $3,957.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,140.81 / $2,610.27 / $3,781.04
| Professional | | $2,140.81 | $2,610.27 | $3,781.04 |
- 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
- $1,506.06 / $2,554.16 / $3,326.34
| Professional | | $1,506.06 | $2,554.16 | $3,326.34 |