- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,711.10 / $8,907.90 / $11,803.40
| Facility | | $2,711.10 | $8,907.90 | $11,803.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,546.50 / $2,711.10 / $4,553.49
| Professional | | $2,546.50 | $2,711.10 | $4,553.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,891.97 / $4,475.89 / $12,126.36
| Facility | | $2,891.97 | $4,475.89 | $12,126.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.80 / $3,873.00 / $15,358.88
| Professional | | $2,323.80 | $3,873.00 | $15,358.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.00 / $5,538.39 / $10,387.39
| Facility | | $3,873.00 | $5,538.39 | $10,387.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,640.62 / $3,640.62 / $3,756.81
| Professional | | $3,640.62 | $3,640.62 | $3,756.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,491.77 / $2,798.36 / $8,811.08
| Facility | | $2,491.77 | $2,798.36 | $8,811.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,011.82 / $4,086.27 / $10,096.86
| Professional | | $2,011.82 | $4,086.27 | $10,096.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $5,585.00 / $21,309.25
| Facility | | $83.43 | $5,585.00 | $21,309.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,588.36 / $5,588.36 / $6,574.54
| Professional | | $5,588.36 | $5,588.36 | $6,574.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,873.00 / $3,873.00 / $11,994.29
| Professional | | $3,873.00 | $3,873.00 | $11,994.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,739.02 / $18,396.75 / $18,396.75
| Facility | | $6,739.02 | $18,396.75 | $18,396.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.80 / $2,323.80 / $19,365.00
| Professional | | $2,323.80 | $2,323.80 | $19,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,485.70 / $3,873.00 / $4,647.60
| Facility | | $3,485.70 | $3,873.00 | $4,647.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.80 / $2,323.80 / $6,777.75
| Professional | | $2,323.80 | $2,323.80 | $6,777.75 |