- 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
- $1,209.80 / $1,209.80 / $7,095.75
| Professional | | $1,209.80 | $1,209.80 | $7,095.75 |
- 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
- $1,167.43 / $1,989.94 / $2,653.26
| Professional | | $1,167.43 | $1,989.94 | $2,653.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,775.57 / $3,018.89 / $4,047.21
| Professional | | $1,775.57 | $3,018.89 | $4,047.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,542.50 / $2,298.62 / $13,909.00
| Facility | | $1,542.50 | $2,298.62 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,653.42 / $2,850.82 / $19,381.65
| Professional | | $1,653.42 | $2,850.82 | $19,381.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,432.82 / $3,023.31 / $4,047.21
| Facility | | $2,432.82 | $3,023.31 | $4,047.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,239.00 / $3,004.34 / $3,702.02
| Professional | | $2,239.00 | $3,004.34 | $3,702.02 |
- 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
- $1,907.79 / $2,734.50 / $3,561.21
| Professional | | $1,907.79 | $2,734.50 | $3,561.21 |