- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,917.20 / $8,477.27 / $19,276.96
| Facility | | $4,917.20 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,001.24 / $5,001.24 / $5,001.24
| Professional | | $5,001.24 | $5,001.24 | $5,001.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,172.22 / $19,955.61 / $38,600.60
| Facility | | $15,172.22 | $19,955.61 | $38,600.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.60 / $937.73 / $3,849.32
| Professional | | $412.60 | $937.73 | $3,849.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,085.35 / $10,595.22 / $16,712.34
| Professional | | $2,085.35 | $10,595.22 | $16,712.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,001.24 / $8,752.17 / $18,892.68
| Facility | | $5,001.24 | $8,752.17 | $18,892.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.66 / $2,362.86 / $4,833.64
| Professional | | $1,383.66 | $2,362.86 | $4,833.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,147.85 / $3,466.32 / $10,595.22
| Facility | | $2,147.85 | $3,466.32 | $10,595.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.48 / $2,721.05 / $10,595.22
| Professional | | $2,137.48 | $2,721.05 | $10,595.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $9,696.00 / $15,622.00
| Facility | | $8,148.00 | $9,696.00 | $15,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.66 / $2,504.63 / $3,138.97
| Professional | | $1,383.66 | $2,504.63 | $3,138.97 |