- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,810.12 / $26,106.65 / $49,939.07
| Facility | | $9,810.12 | $26,106.65 | $49,939.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,409.10 / $2,415.17 / $8,811.15
| Professional | | $1,409.10 | $2,415.17 | $8,811.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,428.82 / $10,782.13 / $25,347.40
| Facility | | $8,428.82 | $10,782.13 | $25,347.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,088.36 / $10,782.13 / $19,253.54
| Professional | | $3,088.36 | $10,782.13 | $19,253.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $50.00 / $50.00
| Professional | | $45.00 | $50.00 | $50.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.28 / $7,317.68 / $11,335.40
| Facility | | $668.28 | $7,317.68 | $11,335.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.68 / $1,500.79 / $4,273.27
| Facility | | $1,379.68 | $1,500.79 | $4,273.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.89 / $2,321.51 / $2,829.71
| Professional | | $1,488.89 | $2,321.51 | $2,829.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,049.61 / $26,106.65 / $49,939.07
| Facility | | $19,049.61 | $26,106.65 | $49,939.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,409.10 / $1,963.80 / $2,711.67
| Professional | | $1,409.10 | $1,963.80 | $2,711.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,391.88 / $1,878.20 / $2,921.29
| Professional | | $1,391.88 | $1,878.20 | $2,921.29 |