- 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
- $2,246.92 / $2,246.92 / $13,307.00
| Professional | | $2,246.92 | $2,246.92 | $13,307.00 |
- 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
- $2,176.61 / $3,710.15 / $4,946.85
| Professional | | $2,176.61 | $3,710.15 | $4,946.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,535.83 / $5,636.76 / $7,458.04
| Professional | | $4,535.83 | $5,636.76 | $7,458.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,584.71 / $3,932.13 / $7,856.00
| Facility | | $2,584.71 | $3,932.13 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,021.33 / $5,684.73 / $18,732.72
| Professional | | $3,021.33 | $5,684.73 | $18,732.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,252.46 / $5,718.46 / $7,458.04
| Facility | | $4,252.46 | $5,718.46 | $7,458.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,824.37 / $5,636.76 / $7,458.04
| Professional | | $3,824.37 | $5,636.76 | $7,458.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $3,183.30 / $6,624.60
| Professional | | $11.00 | $3,183.30 | $6,624.60 |
- 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
- $3,486.15 / $5,416.08 / $6,507.48
| Professional | | $3,486.15 | $5,416.08 | $6,507.48 |