- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,611.47 / $24,068.03
| Facility | | $5,463.36 | $11,611.47 | $24,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.15 / $1,479.15 / $8,244.19
| Professional | | $1,479.15 | $1,479.15 | $8,244.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,970.26 / $10,801.75 / $20,277.64
| Facility | | $7,970.26 | $10,801.75 | $20,277.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,415.55 / $2,406.51 / $3,217.15
| Professional | | $1,415.55 | $2,406.51 | $3,217.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,942.07 / $3,656.17 / $4,675.93
| Professional | | $2,942.07 | $3,656.17 | $4,675.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,572.58 / $2,810.39 / $8,816.00
| Facility | | $1,572.58 | $2,810.39 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,980.76 / $3,575.06 / $11,786.72
| Professional | | $1,980.76 | $3,575.06 | $11,786.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,664.00 / $3,656.17 / $5,383.60
| Facility | | $2,664.00 | $3,656.17 | $5,383.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,370.17 / $3,466.49 / $4,675.93
| Professional | | $2,370.17 | $3,466.49 | $4,675.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $2,122.40 / $4,163.50
| Professional | | $5.00 | $2,122.40 | $4,163.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,200.85 / $3,420.11 / $3,820.64
| Professional | | $2,200.85 | $3,420.11 | $3,820.64 |