- 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
- $1,052.02 / $1,052.02 / $6,188.70
| Professional | | $1,052.02 | $1,052.02 | $6,188.70 |
- 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
- $1,014.14 / $1,728.64 / $2,304.84
| Professional | | $1,014.14 | $1,728.64 | $2,304.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,578.86 / $2,626.63 / $3,531.47
| Professional | | $1,578.86 | $2,626.63 | $3,531.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.33 / $2,117.41 / $13,909.00
| Facility | | $1,341.33 | $2,117.41 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,450.72 / $2,567.91 / $10,151.00
| Professional | | $1,450.72 | $2,567.91 | $10,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,113.35 / $2,626.63 / $3,531.47
| Facility | | $2,113.35 | $2,626.63 | $3,531.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,015.44 / $2,626.63 / $3,246.68
| Professional | | $2,015.44 | $2,626.63 | $3,246.68 |
- 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
- $1,450.72 / $2,567.91 / $3,230.30
| Professional | | $1,450.72 | $2,567.91 | $3,230.30 |