- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,719.00 / $20,928.72
| Facility | | $5,463.36 | $10,719.00 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.92 / $1,186.92 / $1,186.92
| Professional | | $1,186.92 | $1,186.92 | $1,186.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,731.81 / $33,844.37 / $65,465.93
| Facility | | $25,731.81 | $33,844.37 | $65,465.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.72 / $2,846.11 / $3,794.80
| Professional | | $1,669.72 | $2,846.11 | $3,794.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,138.34 / $2,722.94 / $4,509.60
| Professional | | $2,138.34 | $2,722.94 | $4,509.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.92 / $2,077.11 / $16,770.38
| Facility | | $1,186.92 | $2,077.11 | $16,770.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,217.16 / $3,776.52 / $5,029.78
| Professional | | $2,217.16 | $3,776.52 | $5,029.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,138.34 / $2,373.12 / $3,212.31
| Facility | | $2,138.34 | $2,373.12 | $3,212.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,138.34 / $2,373.12 / $4,509.60
| Professional | | $2,138.34 | $2,373.12 | $4,509.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,217.16 / $3,786.23 / $4,920.72
| Professional | | $2,217.16 | $3,786.23 | $4,920.72 |