- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,456.54 / $15,488.17
| Facility | | $2,187.76 | $6,456.54 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,905.46 / $2,454.71
| Professional | | $1,258.93 | $1,905.46 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $22,387.21 / $38,018.94
| Facility | | $12,882.50 | $22,387.21 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,778.28 / $2,454.71
| Professional | | $1,258.93 | $1,778.28 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $15,848.93 / $18,197.01
| Professional | | $5,370.32 | $15,848.93 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Professional | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,905.46 / $2,398.83
| Professional | | $1,621.81 | $1,905.46 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,187.76 / $3,388.44
| Facility | | $1,445.44 | $2,187.76 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,162.28 / $50,118.72
| Facility | | $1,778.28 | $3,162.28 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,162.28 / $50,118.72
| Professional | | $1,778.28 | $3,162.28 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $54,954.09 / $114,815.36
| Facility | | $26,302.68 | $54,954.09 | $114,815.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,819.70 / $3,235.94
| Professional | | $1,288.25 | $1,819.70 | $3,235.94 |