- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,691.53 / $11,481.54
| Facility | | $1,659.59 | $2,691.53 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,819.70 / $4,168.69
| Professional | | $1,548.82 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,754.23 / $4,570.88
| Professional | | $1,905.46 | $2,754.23 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,344.23 / $4,265.80
| Professional | | $1,698.24 | $2,344.23 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $3,890.45
| Professional | | $2,884.03 | $2,884.03 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,238.72 / $3,467.37
| Facility | | $1,659.59 | $2,238.72 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,884.03 / $3,630.78
| Professional | | $2,290.87 | $2,884.03 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $15,135.61 / $22,908.68
| Facility | | $5,370.32 | $15,135.61 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,905.46 / $3,548.13
| Professional | | $1,412.54 | $1,905.46 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $13,489.63 / $13,489.63
| Facility | | $56.23 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,454.40 / $16,982.44 / $16,982.44
| Professional | | $14,454.40 | $16,982.44 | $16,982.44 |