- 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
- $1,629.60 / $1,629.60 / $9,608.51
| Professional | | $1,629.60 | $1,629.60 | $9,608.51 |
- 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
- $1,580.53 / $2,694.07 / $3,592.11
| Professional | | $1,580.53 | $2,694.07 | $3,592.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,293.67 / $4,093.11 / $5,383.45
| Professional | | $3,293.67 | $4,093.11 | $5,383.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,876.07 / $2,851.80 / $7,856.00
| Facility | | $1,876.07 | $2,851.80 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,180.65 / $4,114.71 / $13,585.92
| Professional | | $2,180.65 | $4,114.71 | $13,585.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.67 / $4,116.00 / $5,901.01
| Facility | | $3,293.67 | $4,116.00 | $5,901.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,765.65 / $4,093.11 / $5,383.45
| Professional | | $2,765.65 | $4,093.11 | $5,383.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,777.90 / $4,804.10
| Professional | | $11.00 | $2,777.90 | $4,804.10 |
- 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
- $2,348.39 / $4,114.71 / $4,868.29
| Professional | | $2,348.39 | $4,114.71 | $4,868.29 |