- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,943.28 / $14,454.40
| Facility | | $2,454.71 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $6,606.93
| Professional | | $1,122.02 | $1,479.11 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $27,542.29 / $53,703.18
| Facility | | $20,892.96 | $27,542.29 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,819.70 / $2,454.71
| Professional | | $1,071.52 | $1,819.70 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,818.38 / $3,801.89
| Professional | | $1,659.59 | $2,818.38 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,454.71 / $23,442.29
| Facility | | $1,445.44 | $2,454.71 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,570.40 / $12,882.50
| Professional | | $1,548.82 | $2,570.40 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,884.03 / $3,981.07
| Professional | | $2,818.38 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Professional | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,398.83 / $3,311.31
| Professional | | $1,737.80 | $2,398.83 | $3,311.31 |