- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,495.41 / $10,715.19
| Facility | | $2,089.30 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,148.15 / $3,090.30
| Professional | | $1,000.00 | $1,148.15 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $26,915.35 / $56,234.13
| Facility | | $16,982.44 | $26,915.35 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,584.89 / $2,454.71
| Professional | | $1,230.27 | $1,584.89 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $9,549.93 / $30,199.52
| Facility | | $1,862.09 | $9,549.93 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $2,344.23
| Professional | | $1,122.02 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,479.11 / $5,370.32
| Professional | | $1,047.13 | $1,479.11 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,445.44
| Professional | | $1,047.13 | $1,047.13 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $12,022.64 / $18,620.87
| Facility | | $8,511.38 | $12,022.64 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $2,691.53
| Professional | | $1,122.02 | $1,479.11 | $2,691.53 |