- 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
- $2,181.92 / $2,181.92 / $12,890.80
| Professional | | $2,181.92 | $2,181.92 | $12,890.80 |
- 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
- $2,114.32 / $3,603.96 / $4,805.29
| Professional | | $2,114.32 | $3,603.96 | $4,805.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,406.03 / $5,475.46 / $7,219.14
| Professional | | $4,406.03 | $5,475.46 | $7,219.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,510.44 / $3,818.36 / $7,856.00
| Facility | | $2,510.44 | $3,818.36 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,925.91 / $5,519.48 / $18,185.04
| Professional | | $2,925.91 | $5,519.48 | $18,185.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,406.03 / $5,569.55 / $7,979.77
| Facility | | $4,406.03 | $5,569.55 | $7,979.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,688.64 / $5,519.48 / $7,219.14
| Professional | | $3,688.64 | $5,519.48 | $7,219.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $3,642.70 / $6,433.20
| Professional | | $11.00 | $3,642.70 | $6,433.20 |
- 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
- $3,376.05 / $5,245.03 / $6,301.96
| Professional | | $3,376.05 | $5,245.03 | $6,301.96 |