- 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
- $1,150.35 / $1,150.35 / $6,642.03
| Professional | | $1,150.35 | $1,150.35 | $6,642.03 |
- 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
- $1,110.42 / $1,892.77 / $2,523.69
| Professional | | $1,110.42 | $1,892.77 | $2,523.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,944.00 / $2,794.46 / $3,746.35
| Professional | | $1,944.00 | $2,794.46 | $3,746.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.35 / $2,013.13 / $7,441.00
| Facility | | $1,150.35 | $2,013.13 | $7,441.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,539.21 / $2,545.62 / $3,479.56
| Professional | | $1,539.21 | $2,545.62 | $3,479.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.49 / $2,864.32 / $3,932.53
| Facility | | $1,471.49 | $2,864.32 | $3,932.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,121.17 / $2,576.15 / $3,746.35
| Professional | | $2,121.17 | $2,576.15 | $3,746.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,539.21 / $2,628.50 / $3,315.23
| Professional | | $1,539.21 | $2,628.50 | $3,315.23 |