- 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
- $1,051.88 / $1,051.88 / $6,196.71
| Professional | | $1,051.88 | $1,051.88 | $6,196.71 |
- 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
- $1,014.04 / $1,728.47 / $2,304.63
| Professional | | $1,014.04 | $1,728.47 | $2,304.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,580.93 / $2,626.63 / $3,531.94
| Professional | | $1,580.93 | $2,626.63 | $3,531.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.15 / $2,114.29 / $13,909.00
| Facility | | $1,341.15 | $2,114.29 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.47 / $2,575.52 / $10,997.00
| Professional | | $1,453.47 | $2,575.52 | $10,997.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,113.15 / $2,626.63 / $3,531.94
| Facility | | $2,113.15 | $2,626.63 | $3,531.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,848.47 / $2,626.63 / $3,531.94
| Professional | | $1,848.47 | $2,626.63 | $3,531.94 |
- 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
- $1,453.47 / $2,482.07 / $3,130.54
| Professional | | $1,453.47 | $2,482.07 | $3,130.54 |