- 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
- $1,612.19 / $1,612.19 / $3,661.22
| Professional | | $1,612.19 | $1,612.19 | $3,661.22 |
- 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
- $1,563.63 / $2,665.28 / $3,553.69
| Professional | | $1,563.63 | $2,665.28 | $3,553.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,258.43 / $4,049.31 / $5,347.24
| Professional | | $3,258.43 | $4,049.31 | $5,347.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,856.12 / $2,821.33 / $7,856.00
| Facility | | $1,856.12 | $2,821.33 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,157.21 / $4,070.48 / $13,439.44
| Professional | | $2,157.21 | $4,070.48 | $13,439.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,258.43 / $4,088.48 / $5,807.36
| Facility | | $3,258.43 | $4,088.48 | $5,807.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,735.76 / $4,049.31 / $5,347.24
| Professional | | $2,735.76 | $4,049.31 | $5,347.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,946.10 / $4,751.00
| Professional | | $11.00 | $2,946.10 | $4,751.00 |
- 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
- $2,404.44 / $3,867.04 / $4,646.29
| Professional | | $2,404.44 | $3,867.04 | $4,646.29 |