- 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
- $1,938.91 / $1,938.91 / $11,358.30
| Professional | | $1,938.91 | $1,938.91 | $11,358.30 |
- 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
- $1,867.95 / $3,184.01 / $4,245.34
| Professional | | $1,867.95 | $3,184.01 | $4,245.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,859.80 / $4,828.21 / $6,460.06
| Professional | | $2,859.80 | $4,828.21 | $6,460.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,038.30 / $3,393.09 / $13,909.00
| Facility | | $2,038.30 | $3,393.09 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,638.14 / $4,457.80 / $15,864.88
| Professional | | $2,638.14 | $4,457.80 | $15,864.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,534.69 / $4,828.21 / $6,460.06
| Facility | | $2,534.69 | $4,828.21 | $6,460.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,420.69 / $4,828.21 / $5,946.02
| Professional | | $2,420.69 | $4,828.21 | $5,946.02 |
- 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
- $2,638.14 / $4,758.09 / $5,026.68
| Professional | | $2,638.14 | $4,758.09 | $5,026.68 |