- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,943.28 / $14,454.40
| Facility | | $2,951.21 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,949.84 / $8,317.64
| Professional | | $1,445.44 | $1,949.84 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $23,988.33 / $46,773.51
| Facility | | $18,620.87 | $23,988.33 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,344.23 / $3,090.30
| Professional | | $1,380.38 | $2,344.23 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,548.13 / $4,786.30
| Professional | | $2,137.96 | $3,548.13 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,951.21 / $30,199.52
| Facility | | $1,621.81 | $2,951.21 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,467.37 / $11,748.98
| Professional | | $2,089.30 | $3,467.37 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,715.35 / $5,128.61
| Professional | | $3,548.13 | $3,715.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Professional | | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $4,570.88
| Professional | | $2,398.83 | $3,162.28 | $4,570.88 |