- 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
- $1,489.39 / $1,489.39 / $8,771.12
| Professional | | $1,489.39 | $1,489.39 | $8,771.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,735.08 / $44,370.85 / $85,827.55
| Facility | | $33,735.08 | $44,370.85 | $85,827.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,434.08 / $2,444.46 / $3,259.29
| Professional | | $1,434.08 | $2,444.46 | $3,259.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,199.46 / $3,713.84 / $5,005.34
| Professional | | $2,199.46 | $3,713.84 | $5,005.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,898.97 / $2,812.87 / $13,909.00
| Facility | | $1,898.97 | $2,812.87 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,049.42 / $3,507.28 / $15,161.85
| Professional | | $2,049.42 | $3,507.28 | $15,161.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,988.48 / $3,697.94 / $5,005.34
| Facility | | $2,988.48 | $3,697.94 | $5,005.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,841.00 / $3,697.94 / $5,005.34
| Professional | | $2,841.00 | $3,697.94 | $5,005.34 |
- 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
- $2,049.42 / $3,507.28 / $4,569.89
| Professional | | $2,049.42 | $3,507.28 | $4,569.89 |