- 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
- $1,043.55 / $1,043.55 / $6,140.54
| Professional | | $1,043.55 | $1,043.55 | $6,140.54 |
- 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
- $1,006.38 / $1,715.41 / $2,287.21
| Professional | | $1,006.38 | $1,715.41 | $2,287.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,567.23 / $2,606.96 / $3,503.81
| Professional | | $1,567.23 | $2,606.96 | $3,503.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.53 / $2,108.05 / $13,909.00
| Facility | | $1,330.53 | $2,108.05 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,439.41 / $2,631.61 / $10,743.00
| Professional | | $1,439.41 | $2,631.61 | $10,743.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.17 / $2,606.96 / $3,503.81
| Facility | | $2,097.17 | $2,606.96 | $3,503.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.07 / $2,606.96 / $3,221.18
| Professional | | $2,000.07 | $2,606.96 | $3,221.18 |
- 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
- $1,660.86 / $2,380.57 / $3,100.27
| Professional | | $1,660.86 | $2,380.57 | $3,100.27 |