- 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
- $1,095.31 / $1,095.31 / $6,418.97
| Professional | | $1,095.31 | $1,095.31 | $6,418.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.41 / $9,976.87 / $19,298.50
| Facility | | $7,585.41 | $9,976.87 | $19,298.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.58 / $1,794.19 / $2,392.26
| Professional | | $1,052.58 | $1,794.19 | $2,392.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,523.68 / $2,725.89 / $3,653.85
| Professional | | $1,523.68 | $2,725.89 | $3,653.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,396.52 / $2,050.44 / $13,909.00
| Facility | | $1,396.52 | $2,050.44 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,498.35 / $2,607.81 / $8,951.20
| Professional | | $1,498.35 | $2,607.81 | $8,951.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,193.48 / $2,725.89 / $3,653.85
| Facility | | $2,193.48 | $2,725.89 | $3,653.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,071.00 / $2,534.92 / $3,349.60
| Professional | | $2,071.00 | $2,534.92 | $3,349.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,728.87 / $2,607.81 / $3,227.22
| Professional | | $1,728.87 | $2,607.81 | $3,227.22 |