- 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
- $1,269.51 / $1,269.51 / $7,430.16
| Professional | | $1,269.51 | $1,269.51 | $7,430.16 |
- 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
- $1,220.32 / $2,080.11 / $2,773.48
| Professional | | $1,220.32 | $2,080.11 | $2,773.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,840.77 / $3,160.29 / $4,254.46
| Professional | | $1,840.77 | $3,160.29 | $4,254.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.63 / $2,358.14 / $13,909.00
| Facility | | $1,618.63 | $2,358.14 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,734.30 / $2,996.78 / $10,343.44
| Professional | | $1,734.30 | $2,996.78 | $10,343.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,541.00 / $3,158.38 / $4,254.46
| Facility | | $2,541.00 | $3,158.38 | $4,254.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,325.00 / $3,130.25 / $3,875.07
| Professional | | $2,325.00 | $3,130.25 | $3,875.07 |
- 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
- $2,001.12 / $3,109.74 / $3,884.58
| Professional | | $2,001.12 | $3,109.74 | $3,884.58 |