- 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
- $1,109.88 / $1,109.88 / $6,503.63
| Professional | | $1,109.88 | $1,109.88 | $6,503.63 |
- 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
- $1,070.92 / $1,825.44 / $2,433.92
| Professional | | $1,070.92 | $1,825.44 | $2,433.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.28 / $2,773.35 / $3,720.47
| Professional | | $1,628.28 | $2,773.35 | $3,720.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,415.10 / $2,108.77 / $13,909.00
| Facility | | $1,415.10 | $2,108.77 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,514.70 / $2,717.36 / $20,100.03
| Professional | | $1,514.70 | $2,717.36 | $20,100.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,231.67 / $2,773.35 / $3,720.47
| Facility | | $2,231.67 | $2,773.35 | $3,720.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,071.00 / $2,757.62 / $3,391.49
| Professional | | $2,071.00 | $2,757.62 | $3,391.49 |
- 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
- $1,514.70 / $2,715.96 / $3,398.72
| Professional | | $1,514.70 | $2,715.96 | $3,398.72 |