- 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
- $2,081.07 / $2,081.07 / $12,237.50
| Professional | | $2,081.07 | $2,081.07 | $12,237.50 |
- 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
- $1,997.11 / $3,404.19 / $4,538.92
| Professional | | $1,997.11 | $3,404.19 | $4,538.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,031.82 / $5,171.93 / $6,987.25
| Professional | | $3,031.82 | $5,171.93 | $6,987.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,653.36 / $3,660.80 / $13,909.00
| Facility | | $2,653.36 | $3,660.80 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,863.73 / $4,979.93 / $18,209.83
| Professional | | $2,863.73 | $4,979.93 | $18,209.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,762.96 / $5,126.60 / $6,987.25
| Facility | | $3,762.96 | $5,126.60 | $6,987.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,497.00 / $5,126.60 / $6,387.71
| Professional | | $3,497.00 | $5,126.60 | $6,387.71 |
- 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
- $2,863.73 / $4,979.93 / $6,397.86
| Professional | | $2,863.73 | $4,979.93 | $6,397.86 |