- 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
- $1,436.79 / $1,436.79 / $8,999.11
| Professional | | $1,436.79 | $1,436.79 | $8,999.11 |
- 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
- $1,384.44 / $2,359.82 / $3,146.44
| Professional | | $1,384.44 | $2,359.82 | $3,146.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,161.09 / $3,587.31 / $4,825.74
| Professional | | $2,161.09 | $3,587.31 | $4,825.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,637.82 / $2,920.27 / $13,909.00
| Facility | | $1,637.82 | $2,920.27 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,105.86 / $3,515.11 / $11,802.08
| Professional | | $2,105.86 | $3,515.11 | $11,802.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,885.03 / $3,587.31 / $4,825.74
| Facility | | $2,885.03 | $3,587.31 | $4,825.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,757.56 / $3,587.31 / $4,711.10
| Professional | | $2,757.56 | $3,587.31 | $4,711.10 |
- 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
- $2,105.86 / $3,482.76 / $4,535.68
| Professional | | $2,105.86 | $3,482.76 | $4,535.68 |