- 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
- $1,101.96 / $1,101.96 / $6,354.73
| Professional | | $1,101.96 | $1,101.96 | $6,354.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,921.80 / $10,419.34 / $20,154.36
| Facility | | $7,921.80 | $10,419.34 | $20,154.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.16 / $1,817.31 / $2,423.09
| Professional | | $1,066.16 | $1,817.31 | $2,423.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,751.00 / $2,687.28 / $3,602.64
| Professional | | $1,751.00 | $2,687.28 | $3,602.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,101.96 / $1,928.43 / $7,120.40
| Facility | | $1,101.96 | $1,928.43 | $7,120.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.79 / $2,430.81 / $3,328.58
| Professional | | $1,469.79 | $2,430.81 | $3,328.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,381.76 / $2,696.49 / $3,756.30
| Facility | | $1,381.76 | $2,696.49 | $3,756.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,028.00 / $2,475.91 / $3,602.64
| Professional | | $2,028.00 | $2,475.91 | $3,602.64 |
- 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
- $1,469.79 / $2,489.88 / $3,165.71
| Professional | | $1,469.79 | $2,489.88 | $3,165.71 |