- 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
- $1,207.25 / $1,207.25 / $7,123.84
| Professional | | $1,207.25 | $1,207.25 | $7,123.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,383.91 / $11,027.13 / $21,330.03
| Facility | | $8,383.91 | $11,027.13 | $21,330.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,163.14 / $1,982.61 / $2,643.48
| Professional | | $1,163.14 | $1,982.61 | $2,643.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,815.61 / $3,014.53 / $4,055.34
| Professional | | $1,815.61 | $3,014.53 | $4,055.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,539.24 / $2,439.94 / $13,909.00
| Facility | | $1,539.24 | $2,439.94 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.88 / $2,960.99 / $10,151.00
| Professional | | $1,670.88 | $2,960.99 | $10,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.86 / $3,014.53 / $4,055.34
| Facility | | $2,423.86 | $3,014.53 | $4,055.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,121.46 / $3,014.53 / $3,736.63
| Professional | | $2,121.46 | $3,014.53 | $3,736.63 |
- 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
- $1,670.88 / $2,853.34 / $3,183.66
| Professional | | $1,670.88 | $2,853.34 | $3,183.66 |