- 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
- $1,492.99 / $1,492.99 / $1,492.99
| Professional | | $1,492.99 | $1,492.99 | $1,492.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,744.80 / $41,753.08 / $80,763.95
| Facility | | $31,744.80 | $41,753.08 | $80,763.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,173.90 / $2,000.97 / $2,667.96
| Professional | | $1,173.90 | $2,000.97 | $2,667.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,061.69 / $4,440.87 / $5,551.09
| Professional | | $2,061.69 | $4,440.87 | $5,551.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,492.99 / $2,612.73 / $21,152.23
| Facility | | $1,492.99 | $2,612.73 | $21,152.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,026.28 / $3,178.15 / $6,252.34
| Professional | | $2,026.28 | $3,178.15 | $6,252.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,658.74 / $3,661.44 / $4,765.79
| Facility | | $2,658.74 | $3,661.44 | $4,765.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,993.08 / $3,661.44 / $5,182.89
| Professional | | $2,993.08 | $3,661.44 | $5,182.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $7,856.00
| Facility | | $3,054.00 | $4,317.00 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,026.28 / $3,351.16 / $4,798.51
| Professional | | $2,026.28 | $3,351.16 | $4,798.51 |