- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $8,477.27 / $21,899.37
| Facility | | $4,241.22 | $8,477.27 | $21,899.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,565.89 / $1,565.89 / $8,297.67
| Professional | | $1,565.89 | $1,565.89 | $8,297.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,999.34 / $17,097.68 / $33,072.44
| Facility | | $12,999.34 | $17,097.68 | $33,072.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,501.69 / $2,559.69 / $3,412.92
| Professional | | $1,501.69 | $2,559.69 | $3,412.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,879.24 / $20,879.24 / $20,879.24
| Facility | | $20,879.24 | $20,879.24 | $20,879.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,410.00 / $3,699.17 / $4,929.49
| Professional | | $2,410.00 | $3,699.17 | $4,929.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.89 / $2,740.31 / $11,911.44
| Facility | | $1,565.89 | $2,740.31 | $11,911.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,042.01 / $3,377.18 / $4,605.38
| Professional | | $2,042.01 | $3,377.18 | $4,605.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,013.56 / $3,888.92 / $25,680.89
| Facility | | $2,013.56 | $3,888.92 | $25,680.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,609.58 / $3,422.07 / $4,929.49
| Professional | | $2,609.58 | $3,422.07 | $4,929.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,210.00 / $7,221.00 / $16,246.21
| Facility | | $6,210.00 | $7,221.00 | $16,246.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,042.01 / $3,513.29 / $4,398.18
| Professional | | $2,042.01 | $3,513.29 | $4,398.18 |