- 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
- $3,301.61 / $3,324.73 / $6,166.63
| Professional | | $3,301.61 | $3,324.73 | $6,166.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,856.25 / $22,987.11 / $40,340.87
| Facility | | $15,856.25 | $22,987.11 | $40,340.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,179.32 / $5,419.31 / $7,225.75
| Professional | | $3,179.32 | $5,419.31 | $7,225.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,565.63 / $8,192.81 / $11,660.97
| Professional | | $4,565.63 | $8,192.81 | $11,660.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,819.63 / $5,117.50 / $8,099.87
| Facility | | $2,819.63 | $5,117.50 | $8,099.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,231.72 / $7,837.13 / $27,015.52
| Professional | | $5,231.72 | $7,837.13 | $27,015.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,661.12 / $8,192.81 / $11,094.92
| Facility | | $5,661.12 | $8,192.81 | $11,094.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,093.00 / $8,192.81 / $11,094.92
| Professional | | $5,093.00 | $8,192.81 | $11,094.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $4,739.80 / $10,064.79
| Professional | | $15.00 | $4,739.80 | $10,064.79 |
- 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
- $5,231.72 / $7,937.07 / $10,132.62
| Professional | | $5,231.72 | $7,937.07 | $10,132.62 |