- 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
- $1,109.76 / $1,109.76 / $5,959.64
| Professional | | $1,109.76 | $1,109.76 | $5,959.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,362.84 / $10,999.42 / $21,276.43
| Facility | | $8,362.84 | $10,999.42 | $21,276.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,072.59 / $1,828.30 / $2,437.73
| Professional | | $1,072.59 | $1,828.30 | $2,437.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,674.81 / $6,674.81 / $6,674.81
| Facility | | $6,674.81 | $6,674.81 | $6,674.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,704.00 / $2,698.90 / $3,618.22
| Professional | | $1,704.00 | $2,698.90 | $3,618.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.76 / $1,997.57 / $9,496.00
| Facility | | $1,109.76 | $1,997.57 | $9,496.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.27 / $2,446.48 / $3,348.24
| Professional | | $1,479.27 | $2,446.48 | $3,348.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,161.09 / $2,991.51 / $8,947.94
| Facility | | $2,161.09 | $2,991.51 | $8,947.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,814.68 / $2,635.40 / $3,618.22
| Professional | | $1,814.68 | $2,635.40 | $3,618.22 |
- 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
- $1,479.27 / $2,526.14 / $3,186.12
| Professional | | $1,479.27 | $2,526.14 | $3,186.12 |