- 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
- $1,865.72 / $1,865.72 / $3,480.55
| Professional | | $1,865.72 | $1,865.72 | $3,480.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,856.25 / $22,987.11 / $40,340.87
| Facility | | $15,856.25 | $22,987.11 | $40,340.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,797.63 / $3,064.13 / $4,085.52
| Professional | | $1,797.63 | $3,064.13 | $4,085.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,579.15 / $4,630.53 / $6,607.40
| Professional | | $2,579.15 | $4,630.53 | $6,607.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,865.72 / $3,153.07 / $4,483.25
| Facility | | $1,865.72 | $3,153.07 | $4,483.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,930.66 / $4,390.12 / $15,268.40
| Professional | | $2,930.66 | $4,390.12 | $15,268.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,191.00 / $4,647.71 / $6,207.81
| Facility | | $3,191.00 | $4,647.71 | $6,207.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,920.00 / $4,647.71 / $6,207.81
| Professional | | $2,920.00 | $4,647.71 | $6,207.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $2,700.90 / $5,478.30
| Professional | | $7.00 | $2,700.90 | $5,478.30 |
- 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
- $2,913.04 / $4,413.76 / $5,595.07
| Professional | | $2,913.04 | $4,413.76 | $5,595.07 |