- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,623.41 / $18,620.87
| Facility | | $1,949.84 | $5,623.41 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $954.99 / $1,318.26
| Professional | | $691.83 | $954.99 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,548.82 / $2,454.71
| Facility | | $1,148.15 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Professional | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $25,703.96 / $25,703.96
| Facility | | $25,703.96 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $1,621.81
| Professional | | $851.14 | $1,148.15 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,445.44 / $12,022.64
| Facility | | $851.14 | $1,445.44 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,023.29 / $8,511.38
| Professional | | $794.33 | $1,023.29 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,445.44 / $5,623.41
| Facility | | $851.14 | $1,445.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,023.29 / $1,318.26
| Professional | | $812.83 | $1,023.29 | $1,318.26 |