- 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
- $1,604.27 / $1,604.27 / $9,419.07
| Professional | | $1,604.27 | $1,604.27 | $9,419.07 |
- 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
- $1,556.69 / $2,653.44 / $3,537.92
| Professional | | $1,556.69 | $2,653.44 | $3,537.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,243.96 / $4,031.33 / $5,287.94
| Professional | | $3,243.96 | $4,031.33 | $5,287.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,846.45 / $2,807.47 / $7,856.00
| Facility | | $1,846.45 | $2,807.47 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,136.33 / $4,031.09 / $15,979.56
| Professional | | $2,136.33 | $4,031.09 | $15,979.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,812.00 / $3,862.86 / $5,287.94
| Facility | | $2,812.00 | $3,862.86 | $5,287.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,702.42 / $3,862.86 / $5,287.94
| Professional | | $2,702.42 | $3,862.86 | $5,287.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,656.30 / $4,726.89
| Professional | | $11.00 | $2,656.30 | $4,726.89 |
- 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
- $2,300.66 / $3,829.62 / $4,270.60
| Professional | | $2,300.66 | $3,829.62 | $4,270.60 |