- 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
- $1,485.20 / $1,485.20 / $8,744.68
| Professional | | $1,485.20 | $1,485.20 | $8,744.68 |
- 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
- $1,429.76 / $2,437.09 / $3,249.44
| Professional | | $1,429.76 | $2,437.09 | $3,249.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,192.32 / $3,702.63 / $4,990.46
| Professional | | $2,192.32 | $3,702.63 | $4,990.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,893.63 / $3,018.15 / $13,909.00
| Facility | | $1,893.63 | $3,018.15 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,043.18 / $3,496.37 / $21,470.89
| Professional | | $2,043.18 | $3,496.37 | $21,470.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,979.46 / $3,688.96 / $4,990.46
| Facility | | $2,979.46 | $3,688.96 | $4,990.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,843.69 / $3,686.29 / $4,990.46
| Professional | | $2,843.69 | $3,686.29 | $4,990.46 |
- 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
- $2,043.18 / $3,496.37 / $4,555.68
| Professional | | $2,043.18 | $3,496.37 | $4,555.68 |