- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.26 / $4,211.91 / $5,492.98
| Facility | | $1,886.26 | $4,211.91 | $5,492.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,664.35 / $1,841.88 / $1,886.26
| Professional | | $1,664.35 | $1,841.88 | $1,886.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,428.26 / $10,807.16 / $13,647.65
| Facility | | $8,428.26 | $10,807.16 | $13,647.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,549.20 / $1,549.20 / $1,549.20
| Professional | | $1,549.20 | $1,549.20 | $1,549.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.43 / $6,415.47 / $11,368.04
| Facility | | $1,442.43 | $6,415.47 | $11,368.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.60 / $2,549.86 / $3,187.33
| Professional | | $924.60 | $2,549.86 | $3,187.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,662.96 / $2,773.91 / $3,284.31
| Professional | | $2,662.96 | $2,773.91 | $3,284.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,331.48 / $1,464.63 / $2,219.13
| Facility | | $1,331.48 | $1,464.63 | $2,219.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.69 / $1,819.69 / $2,219.13
| Professional | | $1,819.69 | $1,819.69 | $2,219.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,553.39 / $2,574.19 / $5,419.12
| Facility | | $1,553.39 | $2,574.19 | $5,419.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,553.39 / $2,574.19 / $5,419.12
| Professional | | $1,553.39 | $2,574.19 | $5,419.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.03 / $1,109.57 / $1,664.35
| Professional | | $932.03 | $1,109.57 | $1,664.35 |