- 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
- $1,816.72 / $1,816.72 / $10,701.40
| Professional | | $1,816.72 | $1,816.72 | $10,701.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,988.56 / $27,605.70 / $53,398.33
| Facility | | $20,988.56 | $27,605.70 | $53,398.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,749.15 / $2,981.51 / $3,975.34
| Professional | | $1,749.15 | $2,981.51 | $3,975.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,683.61 / $4,529.77 / $6,105.58
| Professional | | $2,683.61 | $4,529.77 | $6,105.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,316.32 / $3,552.45 / $13,909.00
| Facility | | $2,316.32 | $3,552.45 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.73 / $4,270.47 / $5,922.04
| Professional | | $2,500.73 | $4,270.47 | $5,922.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,645.05 / $4,510.14 / $6,105.58
| Facility | | $3,645.05 | $4,510.14 | $6,105.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,480.53 / $4,510.14 / $6,105.58
| Professional | | $3,480.53 | $4,510.14 | $6,105.58 |
- 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
- $2,500.73 / $4,484.00 / $5,592.64
| Professional | | $2,500.73 | $4,484.00 | $5,592.64 |