- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $11,748.98 / $24,547.09
| Facility | | $1,230.27 | $11,748.98 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,122.02 / $1,380.38
| Professional | | $794.33 | $1,122.02 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,995.26 / $2,630.27
| Professional | | $1,513.56 | $1,995.26 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $2,818.38
| Facility | | $977.24 | $1,230.27 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $20,417.38
| Professional | | $794.33 | $1,148.15 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,737.80 / $2,238.72
| Facility | | $1,348.96 | $1,737.80 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,230.27 / $1,778.28
| Facility | | $891.25 | $1,230.27 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $2,290.87
| Professional | | $79.43 | $79.43 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $36,307.81 / $52,480.75
| Facility | | $13,489.63 | $36,307.81 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,187.76 / $2,951.21
| Professional | | $1,659.59 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,892.96 / $56,234.13
| Facility | | $3,019.95 | $20,892.96 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,137.96 / $3,235.94
| Professional | | $1,513.56 | $2,137.96 | $3,235.94 |