- 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
- $1,333.17 / $1,333.17 / $7,660.09
| Professional | | $1,333.17 | $1,333.17 | $7,660.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.60 / $13,313.50 / $24,992.84
| Facility | | $9,823.60 | $13,313.50 | $24,992.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.84 / $2,200.32 / $2,933.78
| Professional | | $1,290.84 | $2,200.32 | $2,933.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,690.01 / $3,342.92 / $4,455.53
| Professional | | $2,690.01 | $3,342.92 | $4,455.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,418.31 / $2,441.04 / $7,856.00
| Facility | | $1,418.31 | $2,441.04 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.15 / $3,372.92 / $10,796.64
| Professional | | $1,889.15 | $3,372.92 | $10,796.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,522.00 / $3,221.71 / $4,455.53
| Facility | | $2,522.00 | $3,221.71 | $4,455.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.40 / $3,165.91 / $4,431.02
| Professional | | $2,271.40 | $3,165.91 | $4,431.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $2,386.19 / $3,590.10
| Professional | | $7.00 | $2,386.19 | $3,590.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $7,856.00
| Facility | | $3,054.00 | $4,317.00 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,099.06 / $3,261.09 / $3,996.84
| Professional | | $2,099.06 | $3,261.09 | $3,996.84 |