- 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
- $3,568.51 / $3,568.51 / $21,186.10
| Professional | | $3,568.51 | $3,568.51 | $21,186.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,086.90 / $12,315.08 / $23,118.55
| Facility | | $9,086.90 | $12,315.08 | $23,118.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,447.21 / $5,875.93 / $7,834.57
| Professional | | $3,447.21 | $5,875.93 | $7,834.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,183.63 / $8,927.23 / $11,778.46
| Professional | | $7,183.63 | $8,927.23 | $11,778.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,678.00 / $6,066.47 / $7,856.00
| Facility | | $3,678.00 | $6,066.47 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,788.95 / $9,005.39 / $29,534.24
| Professional | | $4,788.95 | $9,005.39 | $29,534.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,541.00 / $8,139.52 / $11,896.92
| Facility | | $6,541.00 | $8,139.52 | $11,896.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.31 / $8,139.52 / $11,778.46
| Professional | | $5,248.31 | $8,139.52 | $11,778.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $5,120.70 / $10,575.40
| Professional | | $11.00 | $5,120.70 | $10,575.40 |
- 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
- $5,275.02 / $8,584.75 / $9,391.03
| Professional | | $5,275.02 | $8,584.75 | $9,391.03 |