- 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
- $1,236.54 / $1,236.54 / $7,202.97
| Professional | | $1,236.54 | $1,236.54 | $7,202.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,925.11 / $2,925.11 / $2,925.11
| Professional | | $2,925.11 | $2,925.11 | $2,925.11 |
- 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
- $1,193.08 / $2,033.69 / $2,711.57
| Professional | | $1,193.08 | $2,033.69 | $2,711.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,813.28 / $3,079.31 / $4,078.06
| Professional | | $1,813.28 | $3,079.31 | $4,078.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.54 / $2,163.94 / $7,934.00
| Facility | | $1,236.54 | $2,163.94 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.12 / $2,746.44 / $10,119.04
| Professional | | $1,669.12 | $2,746.44 | $10,119.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,231.00 / $3,079.31 / $4,078.06
| Facility | | $2,231.00 | $3,079.31 | $4,078.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,068.59 / $3,079.31 / $3,771.24
| Professional | | $2,068.59 | $3,079.31 | $3,771.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.70 / $4,217.00 / $7,934.00
| Facility | | $1,172.70 | $4,217.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.12 / $2,972.64 / $3,578.54
| Professional | | $1,669.12 | $2,972.64 | $3,578.54 |