- 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
- $1,603.38 / $1,603.38 / $9,399.60
| Professional | | $1,603.38 | $1,603.38 | $9,399.60 |
- 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
- $1,546.03 / $2,635.28 / $3,513.69
| Professional | | $1,546.03 | $2,635.28 | $3,513.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,354.33 / $4,003.04 / $5,366.60
| Professional | | $2,354.33 | $4,003.04 | $5,366.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.31 / $3,046.42 / $13,909.00
| Facility | | $2,044.31 | $3,046.42 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,191.36 / $3,757.07 / $19,432.00
| Professional | | $2,191.36 | $3,757.07 | $19,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,221.76 / $4,003.74 / $5,366.60
| Facility | | $3,221.76 | $4,003.74 | $5,366.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,982.00 / $3,980.32 / $4,908.72
| Professional | | $2,982.00 | $3,980.32 | $4,908.72 |
- 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
- $2,191.36 / $3,757.07 / $4,895.37
| Professional | | $2,191.36 | $3,757.07 | $4,895.37 |