- 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
- $2,593.63 / $2,593.63 / $15,369.90
| Professional | | $2,593.63 | $2,593.63 | $15,369.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,461.16 / $11,467.05 / $21,526.57
| Facility | | $8,461.16 | $11,467.05 | $21,526.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,512.17 / $4,282.10 / $5,709.48
| Professional | | $2,512.17 | $4,282.10 | $5,709.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,235.10 / $6,505.75 / $8,610.87
| Professional | | $5,235.10 | $6,505.75 | $8,610.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,982.81 / $4,409.17 / $7,856.00
| Facility | | $2,982.81 | $4,409.17 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,488.11 / $6,561.88 / $21,620.88
| Professional | | $3,488.11 | $6,561.88 | $21,620.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,235.10 / $6,615.57 / $9,502.31
| Facility | | $5,235.10 | $6,615.57 | $9,502.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,415.00 / $6,518.12 / $8,610.87
| Professional | | $4,415.00 | $6,518.12 | $8,610.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $4,660.39 / $7,648.40
| Professional | | $11.00 | $4,660.39 | $7,648.40 |
- 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
- $3,756.42 / $6,254.45 / $7,042.12
| Professional | | $3,756.42 | $6,254.45 | $7,042.12 |