- 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
- $1,069.27 / $1,069.27 / $6,284.21
| Professional | | $1,069.27 | $1,069.27 | $6,284.21 |
- 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
- $1,030.55 / $1,756.64 / $2,342.17
| Professional | | $1,030.55 | $1,756.64 | $2,342.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,604.42 / $2,668.84 / $3,589.78
| Professional | | $1,604.42 | $2,668.84 | $3,589.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,363.32 / $2,136.67 / $13,909.00
| Facility | | $1,363.32 | $2,136.67 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,473.10 / $2,604.51 / $15,227.00
| Professional | | $1,473.10 | $2,604.51 | $15,227.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,147.57 / $2,668.84 / $3,589.78
| Facility | | $2,147.57 | $2,668.84 | $3,589.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,044.58 / $2,668.84 / $3,300.42
| Professional | | $2,044.58 | $2,668.84 | $3,300.42 |
- 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
- $1,473.10 / $2,570.53 / $3,280.12
| Professional | | $1,473.10 | $2,570.53 | $3,280.12 |