- 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
- $1,610.92 / $1,610.92 / $9,260.66
| Professional | | $1,610.92 | $1,610.92 | $9,260.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,646.56 / $11,718.32 / $21,998.27
| Facility | | $8,646.56 | $11,718.32 | $21,998.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,558.76 / $2,656.96 / $3,542.63
| Professional | | $1,558.76 | $2,656.96 | $3,542.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,248.29 / $4,036.71 / $5,385.56
| Professional | | $3,248.29 | $4,036.71 | $5,385.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.84 / $2,956.76 / $7,856.00
| Facility | | $1,712.84 | $2,956.76 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,284.81 / $4,075.63 / $13,038.08
| Professional | | $2,284.81 | $4,075.63 | $13,038.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,055.00 / $3,871.55 / $5,385.56
| Facility | | $3,055.00 | $3,871.55 | $5,385.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,760.32 / $3,824.57 / $5,354.94
| Professional | | $2,760.32 | $3,824.57 | $5,354.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $3,003.10 / $4,335.89
| Professional | | $7.00 | $3,003.10 | $4,335.89 |
- 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
- $2,369.42 / $3,944.09 / $4,835.55
| Professional | | $2,369.42 | $3,944.09 | $4,835.55 |