- 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
- $1,710.23 / $1,710.23 / $10,108.70
| Professional | | $1,710.23 | $1,710.23 | $10,108.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,461.16 / $11,467.05 / $21,526.57
| Facility | | $8,461.16 | $11,467.05 | $21,526.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,658.16 / $2,826.40 / $3,768.54
| Professional | | $1,658.16 | $2,826.40 | $3,768.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,455.42 / $4,294.12 / $5,673.02
| Professional | | $3,455.42 | $4,294.12 | $5,673.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,968.89 / $2,992.90 / $7,856.00
| Facility | | $1,968.89 | $2,992.90 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,294.44 / $4,326.88 / $14,256.32
| Professional | | $2,294.44 | $4,326.88 | $14,256.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,370.00 / $4,352.22 / $6,085.72
| Facility | | $3,370.00 | $4,352.22 | $6,085.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,838.34 / $4,294.12 / $5,673.02
| Professional | | $2,838.34 | $4,294.12 | $5,673.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,888.40 / $5,039.89
| Professional | | $11.00 | $2,888.40 | $5,039.89 |
- 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
- $2,470.92 / $4,114.10 / $4,941.85
| Professional | | $2,470.92 | $4,114.10 | $4,941.85 |