- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $8,317.64 / $17,378.01
| Facility | | $1,318.26 | $8,317.64 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $2,238.72
| Professional | | $1,047.13 | $1,288.25 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $37,153.52 / $50,118.72
| Facility | | $15,848.93 | $37,153.52 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,318.26 / $1,819.70
| Professional | | $977.24 | $1,318.26 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,380.38 / $1,905.46
| Professional | | $1,122.02 | $1,380.38 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,412.54 / $2,454.71
| Professional | | $1,047.13 | $1,412.54 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,047.13 / $1,318.26
| Professional | | $870.96 | $1,047.13 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Professional | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $2,398.83
| Facility | | $1,000.00 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,445.44 / $7,413.10
| Facility | | $977.24 | $1,445.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,445.44 / $7,413.10
| Professional | | $977.24 | $1,445.44 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,548.82 / $2,454.71
| Professional | | $954.99 | $1,548.82 | $2,454.71 |