- 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
- $1,418.22 / $1,418.22 / $8,363.51
| Professional | | $1,418.22 | $1,418.22 | $8,363.51 |
- 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
- $1,366.55 / $2,329.36 / $3,105.82
| Professional | | $1,366.55 | $2,329.36 | $3,105.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,133.69 / $3,542.18 / $4,762.68
| Professional | | $2,133.69 | $3,542.18 | $4,762.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,808.23 / $2,812.46 / $13,909.00
| Facility | | $1,808.23 | $2,812.46 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,961.82 / $3,350.18 / $4,718.16
| Professional | | $1,961.82 | $3,350.18 | $4,718.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,847.76 / $3,542.18 / $4,762.68
| Facility | | $2,847.76 | $3,542.18 | $4,762.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,725.07 / $3,542.18 / $4,762.68
| Professional | | $2,725.07 | $3,542.18 | $4,762.68 |
- 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
- $2,263.64 / $3,551.19 / $4,225.45
| Professional | | $2,263.64 | $3,551.19 | $4,225.45 |