- 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
- $1,058.82 / $1,058.82 / $6,126.74
| Professional | | $1,058.82 | $1,058.82 | $6,126.74 |
- 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
- $1,020.39 / $1,739.30 / $2,319.05
| Professional | | $1,020.39 | $1,739.30 | $2,319.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.86 / $2,589.55 / $3,471.63
| Professional | | $1,905.86 | $2,589.55 | $3,471.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.82 / $1,852.94 / $8,163.00
| Facility | | $1,058.82 | $1,852.94 | $8,163.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,420.42 / $2,349.15 / $3,209.81
| Professional | | $1,420.42 | $2,349.15 | $3,209.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,365.30 / $2,622.93 / $3,604.03
| Facility | | $1,365.30 | $2,622.93 | $3,604.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,965.64 / $2,393.44 / $3,471.63
| Professional | | $1,965.64 | $2,393.44 | $3,471.63 |
- 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
- $1,420.42 / $2,406.53 / $3,059.36
| Professional | | $1,420.42 | $2,406.53 | $3,059.36 |