- 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
- $1,506.27 / $1,506.27 / $8,844.48
| Professional | | $1,506.27 | $1,506.27 | $8,844.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,195.75 / $12,462.61 / $23,395.49
| Facility | | $9,195.75 | $12,462.61 | $23,395.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.49 / $2,469.01 / $3,292.02
| Professional | | $1,448.49 | $2,469.01 | $3,292.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,018.50 / $3,751.14 / $5,022.93
| Professional | | $3,018.50 | $3,751.14 | $5,022.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,588.16 / $2,635.97 / $7,856.00
| Facility | | $1,588.16 | $2,635.97 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,220.51 / $3,810.86 / $12,296.88
| Professional | | $2,220.51 | $3,810.86 | $12,296.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,666.86 / $3,727.04 / $5,022.93
| Facility | | $2,666.86 | $3,727.04 | $5,022.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,583.27 / $3,727.04 / $5,022.93
| Professional | | $2,583.27 | $3,727.04 | $5,022.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $1,705.90 / $4,252.70
| Professional | | $12.00 | $1,705.90 | $4,252.70 |
- 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
- $2,379.12 / $3,697.15 / $4,441.02
| Professional | | $2,379.12 | $3,697.15 | $4,441.02 |