- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,011.87 / $15,848.93
| Facility | | $2,089.30 | $5,011.87 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,630.27 / $3,715.35
| Professional | | $1,949.84 | $2,630.27 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $5.01 / $1,905.46
| Professional | | $5.01 | $5.01 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,388.44 / $15,488.17
| Facility | | $2,290.87 | $3,388.44 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $4,677.35
| Professional | | $3,890.45 | $3,890.45 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $16,595.87
| Facility | | $16,595.87 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $26,302.68 / $26,302.68
| Professional | | $17,378.01 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,467.37 / $6,456.54
| Facility | | $2,630.27 | $3,467.37 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,884.03 / $4,365.16
| Professional | | $2,089.30 | $2,884.03 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $12,589.25
| Professional | | $3,388.44 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $9,549.93
| Facility | | $2,454.71 | $3,467.37 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $3,630.78 / $6,165.95
| Professional | | $79.43 | $3,630.78 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,479.11 / $3,467.37
| Facility | | $1,258.93 | $1,479.11 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $2,398.83
| Professional | | $1,479.11 | $1,479.11 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $3,467.37 / $3,467.37
| Professional | | $295.12 | $3,467.37 | $3,467.37 |