- 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
- $1,626.12 / $1,626.12 / $9,588.99
| Professional | | $1,626.12 | $1,626.12 | $9,588.99 |
- 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
- $1,566.83 / $2,670.75 / $3,561.00
| Professional | | $1,566.83 | $2,670.75 | $3,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,448.27 / $4,061.09 / $5,461.93
| Professional | | $2,448.27 | $4,061.09 | $5,461.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.30 / $3,427.41 / $13,909.00
| Facility | | $2,073.30 | $3,427.41 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,249.96 / $3,818.42 / $4,975.31
| Professional | | $2,249.96 | $3,818.42 | $4,975.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,265.12 / $4,061.09 / $5,461.93
| Facility | | $3,265.12 | $4,061.09 | $5,461.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,878.48 / $4,061.09 / $5,461.93
| Professional | | $2,878.48 | $4,061.09 | $5,461.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,126.00 / $4,317.00 / $7,856.00
| Facility | | $3,126.00 | $4,317.00 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,596.11 / $4,034.35 / $4,287.04
| Professional | | $2,596.11 | $4,034.35 | $4,287.04 |