- 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
- $1,609.94 / $1,609.94 / $9,452.59
| Professional | | $1,609.94 | $1,609.94 | $9,452.59 |
- 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
- $1,551.61 / $2,644.80 / $3,526.40
| Professional | | $1,551.61 | $2,644.80 | $3,526.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,368.61 / $4,018.23 / $5,405.19
| Professional | | $2,368.61 | $4,018.23 | $5,405.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,052.67 / $3,058.89 / $13,909.00
| Facility | | $2,052.67 | $3,058.89 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,205.46 / $3,982.00 / $24,716.00
| Professional | | $2,205.46 | $3,982.00 | $24,716.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,233.42 / $4,018.23 / $5,405.19
| Facility | | $3,233.42 | $4,018.23 | $5,405.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,020.00 / $3,997.06 / $4,936.06
| Professional | | $3,020.00 | $3,997.06 | $4,936.06 |
- 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
- $2,205.46 / $3,954.56 / $4,940.12
| Professional | | $2,205.46 | $3,954.56 | $4,940.12 |