- 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
- $1,058.14 / $1,058.14 / $1,058.14
| Professional | | $1,058.14 | $1,058.14 | $1,058.14 |
- 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
- $907.14 / $1,546.28 / $2,061.71
| Professional | | $907.14 | $1,546.28 | $2,061.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,567.93 / $1,996.56 / $2,628.51
| Professional | | $1,567.93 | $1,996.56 | $2,628.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.14 / $1,851.75 / $14,947.57
| Facility | | $1,058.14 | $1,851.75 | $14,947.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,213.98 / $2,071.23 / $3,331.02
| Professional | | $1,213.98 | $2,071.23 | $3,331.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,567.93 / $1,887.26 / $2,628.51
| Facility | | $1,567.93 | $1,887.26 | $2,628.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,567.93 / $1,878.15 / $2,450.05
| Professional | | $1,567.93 | $1,878.15 | $2,450.05 |
- 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
- $1,213.98 / $2,073.10 / $2,614.71
| Professional | | $1,213.98 | $2,073.10 | $2,614.71 |