- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,668.15 / $24,068.03
| Facility | | $5,463.36 | $11,668.15 | $24,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.89 / $1,144.89 / $6,776.34
| Professional | | $1,144.89 | $1,144.89 | $6,776.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,731.81 / $33,844.37 / $65,465.93
| Facility | | $25,731.81 | $33,844.37 | $65,465.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.30 / $1,860.15 / $2,505.26
| Professional | | $1,102.30 | $1,860.15 | $2,505.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,297.11 / $2,800.59 / $3,098.36
| Professional | | $2,297.11 | $2,800.59 | $3,098.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.73 / $2,206.61 / $26,581.96
| Facility | | $1,459.73 | $2,206.61 | $26,581.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.53 / $2,642.93 / $25,915.00
| Professional | | $1,584.53 | $2,642.93 | $25,915.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,297.11 / $2,833.01 / $3,319.05
| Facility | | $2,297.11 | $2,833.01 | $3,319.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,967.00 / $2,616.16 / $3,319.05
| Professional | | $1,967.00 | $2,616.16 | $3,319.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,617.00 / $11,459.00 / $26,782.00
| Facility | | $9,617.00 | $11,459.00 | $26,782.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.53 / $2,657.15 / $3,019.14
| Professional | | $1,584.53 | $2,657.15 | $3,019.14 |