- 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
- $1,331.49 / $1,331.49 / $7,832.74
| Professional | | $1,331.49 | $1,331.49 | $7,832.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,881.23 / $31,009.94 / $58,213.58
| Facility | | $22,881.23 | $31,009.94 | $58,213.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.30 / $2,201.09 / $2,934.79
| Professional | | $1,291.30 | $2,201.09 | $2,934.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,690.96 / $3,344.10 / $4,392.81
| Professional | | $2,690.96 | $3,344.10 | $4,392.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.22 / $2,330.11 / $7,856.00
| Facility | | $1,532.22 | $2,330.11 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,777.11 / $3,353.28 / $11,091.60
| Professional | | $1,777.11 | $3,353.28 | $11,091.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,690.96 / $3,358.58 / $4,853.34
| Facility | | $2,690.96 | $3,358.58 | $4,853.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.76 / $3,344.10 / $4,392.81
| Professional | | $2,238.76 | $3,344.10 | $4,392.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,005.60 / $3,925.10
| Professional | | $11.00 | $2,005.60 | $3,925.10 |
- 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
- $1,913.81 / $3,185.68 / $3,963.23
| Professional | | $1,913.81 | $3,185.68 | $3,963.23 |