- 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
- $1,544.50 / $1,544.50 / $9,068.73
| Professional | | $1,544.50 | $1,544.50 | $9,068.73 |
- 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
- $1,489.05 / $2,538.15 / $3,384.19
| Professional | | $1,489.05 | $2,538.15 | $3,384.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.30 / $3,856.18 / $5,185.35
| Professional | | $2,271.30 | $3,856.18 | $5,185.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,969.24 / $2,934.55 / $13,909.00
| Facility | | $1,969.24 | $2,934.55 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,115.32 / $3,617.91 / $15,690.14
| Professional | | $2,115.32 | $3,617.91 | $15,690.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,103.02 / $3,856.18 / $5,185.35
| Facility | | $3,103.02 | $3,856.18 | $5,185.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,870.00 / $3,834.77 / $4,734.77
| Professional | | $2,870.00 | $3,834.77 | $4,734.77 |
- 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
- $2,440.76 / $3,617.91 / $4,556.08
| Professional | | $2,440.76 | $3,617.91 | $4,556.08 |