- 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
- $2,213.44 / $2,213.44 / $4,116.45
| Professional | | $2,213.44 | $2,213.44 | $4,116.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,489.78 / $7,958.64 / $13,966.90
| Facility | | $5,489.78 | $7,958.64 | $13,966.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,135.07 / $3,639.32 / $4,852.43
| Professional | | $2,135.07 | $3,639.32 | $4,852.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,053.13 / $5,432.25 / $7,802.49
| Professional | | $3,053.13 | $5,432.25 | $7,802.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,213.44 / $3,678.00 / $5,068.35
| Facility | | $2,213.44 | $3,678.00 | $5,068.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,440.91 / $5,154.47 / $18,098.08
| Professional | | $3,440.91 | $5,154.47 | $18,098.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.10 / $5,507.96 / $7,282.65
| Facility | | $4,146.10 | $5,507.96 | $7,282.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,684.53 / $5,507.96 / $7,282.65
| Professional | | $3,684.53 | $5,507.96 | $7,282.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $3,219.20 / $6,326.80
| Professional | | $7.00 | $3,219.20 | $6,326.80 |
- 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
- $3,440.91 / $5,092.55 / $6,423.03
| Professional | | $3,440.91 | $5,092.55 | $6,423.03 |