- 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
- $1,354.39 / $1,354.39 / $7,946.29
| Professional | | $1,354.39 | $1,354.39 | $7,946.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,988.56 / $27,605.70 / $53,398.33
| Facility | | $20,988.56 | $27,605.70 | $53,398.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.67 / $2,217.05 / $2,956.07
| Professional | | $1,300.67 | $2,217.05 | $2,956.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,968.88 / $3,368.32 / $4,542.81
| Professional | | $1,968.88 | $3,368.32 | $4,542.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,726.85 / $2,482.05 / $13,909.00
| Facility | | $1,726.85 | $2,482.05 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,857.21 / $3,213.88 / $12,147.11
| Professional | | $1,857.21 | $3,213.88 | $12,147.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,671.00 / $3,338.39 / $4,542.81
| Facility | | $2,671.00 | $3,338.39 | $4,542.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,351.37 / $3,338.39 / $4,145.54
| Professional | | $2,351.37 | $3,338.39 | $4,145.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,126.00 / $4,317.00 / $7,856.00
| Facility | | $3,126.00 | $4,317.00 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,142.92 / $3,213.88 / $4,000.14
| Professional | | $2,142.92 | $3,213.88 | $4,000.14 |