- 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
- $1,073.33 / $1,073.33 / $6,185.11
| Professional | | $1,073.33 | $1,073.33 | $6,185.11 |
- 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
- $1,037.03 / $1,767.66 / $2,356.88
| Professional | | $1,037.03 | $1,767.66 | $2,356.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,796.00 / $2,610.19 / $3,499.30
| Professional | | $1,796.00 | $2,610.19 | $3,499.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,073.33 / $1,878.33 / $8,163.00
| Facility | | $1,073.33 | $1,878.33 | $8,163.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,431.89 / $2,368.12 / $3,239.91
| Professional | | $1,431.89 | $2,368.12 | $3,239.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,364.93 / $2,675.44 / $3,664.52
| Facility | | $1,364.93 | $2,675.44 | $3,664.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,981.30 / $2,506.73 / $3,499.30
| Professional | | $1,981.30 | $2,506.73 | $3,499.30 |
- 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
- $1,431.89 / $2,356.25 / $3,084.06
| Professional | | $1,431.89 | $2,356.25 | $3,084.06 |