- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,611.47 / $24,068.03
| Facility | | $5,463.36 | $11,611.47 | $24,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.00 / $734.00 / $734.00
| Professional | | $734.00 | $734.00 | $734.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,744.80 / $43,022.36 / $80,763.95
| Facility | | $31,744.80 | $43,022.36 | $80,763.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.48 / $610.16 / $2,774.28
| Professional | | $268.48 | $610.16 | $2,774.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,601.75 / $1,990.53 / $2,362.13
| Professional | | $1,601.75 | $1,990.53 | $2,362.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.00 / $1,284.50 / $9,498.37
| Facility | | $734.00 | $1,284.50 | $9,498.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.68 / $2,050.10 / $6,468.32
| Professional | | $1,246.68 | $2,050.10 | $6,468.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,601.75 / $2,243.73 / $4,996.28
| Facility | | $1,601.75 | $2,243.73 | $4,996.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,564.96 / $1,990.53 / $2,467.39
| Professional | | $1,564.96 | $1,990.53 | $2,467.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.68 / $2,050.10 / $3,195.52
| Professional | | $1,246.68 | $2,050.10 | $3,195.52 |