- 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
- $1,506.92 / $1,506.92 / $8,879.54
| Professional | | $1,506.92 | $1,506.92 | $8,879.54 |
- 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
- $1,451.82 / $2,474.71 / $3,299.61
| Professional | | $1,451.82 | $2,474.71 | $3,299.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,267.32 / $3,762.70 / $5,060.43
| Professional | | $2,267.32 | $3,762.70 | $5,060.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,921.32 / $3,035.56 / $13,909.00
| Facility | | $1,921.32 | $3,035.56 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,083.52 / $3,687.96 / $12,378.16
| Professional | | $2,083.52 | $3,687.96 | $12,378.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,025.48 / $3,762.70 / $5,060.43
| Facility | | $3,025.48 | $3,762.70 | $5,060.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,895.75 / $3,762.70 / $4,663.76
| Professional | | $2,895.75 | $3,762.70 | $4,663.76 |
- 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
- $2,083.52 / $3,687.96 / $4,634.53
| Professional | | $2,083.52 | $3,687.96 | $4,634.53 |