- 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
- $1,235.55 / $1,235.55 / $7,258.10
| Professional | | $1,235.55 | $1,235.55 | $7,258.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,424.50 / $24,233.27 / $46,874.97
| Facility | | $18,424.50 | $24,233.27 | $46,874.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.30 / $2,028.95 / $2,705.26
| Professional | | $1,190.30 | $2,028.95 | $2,705.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,815.00 / $3,082.55 / $4,152.42
| Professional | | $1,815.00 | $3,082.55 | $4,152.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,575.33 / $2,347.55 / $13,909.00
| Facility | | $1,575.33 | $2,347.55 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,693.60 / $2,919.66 / $16,540.23
| Professional | | $1,693.60 | $2,919.66 | $16,540.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,480.48 / $3,082.55 / $4,152.42
| Facility | | $2,480.48 | $3,082.55 | $4,152.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,350.00 / $3,063.29 / $3,791.29
| Professional | | $2,350.00 | $3,063.29 | $3,791.29 |
- 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
- $1,693.60 / $2,919.66 / $3,793.69
| Professional | | $1,693.60 | $2,919.66 | $3,793.69 |