- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,128.61 / $14,791.08
| Facility | | $1,513.56 | $5,128.61 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,137.96 / $7,585.78
| Professional | | $1,230.27 | $2,137.96 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $1,862.09
| Professional | | $1,000.00 | $1,288.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $19,054.61 / $25,703.96
| Professional | | $831.76 | $19,054.61 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,890.45 / $4,786.30
| Professional | | $3,235.94 | $3,890.45 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,995.26 / $4,677.35
| Facility | | $1,513.56 | $1,995.26 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,981.07 / $28,183.83
| Facility | | $1,584.89 | $3,981.07 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,981.07 / $28,183.83
| Professional | | $1,584.89 | $3,981.07 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $18,620.87 / $40,738.03
| Facility | | $10,964.78 | $18,620.87 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,548.82 / $3,090.30
| Professional | | $954.99 | $1,548.82 | $3,090.30 |