- 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
- $2,660.24 / $2,660.24 / $15,641.10
| Professional | | $2,660.24 | $2,660.24 | $15,641.10 |
- 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
- $2,552.88 / $4,351.50 / $5,802.00
| Professional | | $2,552.88 | $4,351.50 | $5,802.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,875.44 / $6,611.17 / $8,932.68
| Professional | | $3,875.44 | $6,611.17 | $8,932.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,391.81 / $4,655.42 / $13,909.00
| Facility | | $3,391.81 | $4,655.42 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,659.36 / $6,338.22 / $23,442.30
| Professional | | $3,659.36 | $6,338.22 | $23,442.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,005.00 / $6,553.08 / $8,932.68
| Facility | | $5,005.00 | $6,553.08 | $8,932.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,581.00 / $6,553.08 / $8,160.87
| Professional | | $4,581.00 | $6,553.08 | $8,160.87 |
- 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
- $3,659.36 / $6,338.22 / $8,176.22
| Professional | | $3,659.36 | $6,338.22 | $8,176.22 |