- 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
- $1,567.31 / $1,567.31 / $1,567.31
| Professional | | $1,567.31 | $1,567.31 | $1,567.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,731.81 / $33,844.37 / $65,465.93
| Facility | | $25,731.81 | $33,844.37 | $65,465.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.72 / $2,846.11 / $3,794.80
| Professional | | $1,669.72 | $2,846.11 | $3,794.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,483.46 / $3,079.05 / $4,152.81
| Professional | | $2,483.46 | $3,079.05 | $4,152.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,567.31 / $2,742.79 / $34,352.32
| Facility | | $1,567.31 | $2,742.79 | $34,352.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,647.27 / $2,955.44 / $4,435.30
| Professional | | $1,647.27 | $2,955.44 | $4,435.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.56 / $3,079.05 / $3,385.99
| Facility | | $2,545.56 | $3,079.05 | $3,385.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,545.56 / $2,956.71 / $3,529.60
| Professional | | $2,545.56 | $2,956.71 | $3,529.60 |
- 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
- $1,647.27 / $2,862.57 / $4,127.93
| Professional | | $1,647.27 | $2,862.57 | $4,127.93 |