- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $14,454.40 / $17,378.01
| Facility | | $1,318.26 | $14,454.40 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,202.26 / $1,949.84
| Professional | | $1,023.29 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Professional | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $40,738.03 / $57,543.99
| Facility | | $25,118.86 | $40,738.03 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,288.25 / $2,041.74
| Professional | | $954.99 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,096.48 / $1,174.90
| Facility | | $1,000.00 | $1,096.48 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,698.24 / $2,454.71
| Facility | | $1,122.02 | $1,698.24 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,380.38 / $3,162.28
| Professional | | $1,071.52 | $1,380.38 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $11,481.54 / $17,378.01
| Facility | | $5,128.61 | $11,481.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,288.25 / $2,137.96
| Professional | | $954.99 | $1,288.25 | $2,137.96 |