- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,511.38 / $14,454.40
| Facility | | $4,265.80 | $8,511.38 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,258.93 / $5,370.32
| Professional | | $933.25 | $1,258.93 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $32,359.37 / $66,069.34
| Facility | | $25,703.96 | $32,359.37 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,513.56 / $2,041.74
| Professional | | $891.25 | $1,513.56 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,290.87 / $3,162.28
| Professional | | $1,348.96 | $2,290.87 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,778.28 / $13,182.57
| Facility | | $1,174.90 | $1,778.28 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,137.96 / $2,951.21
| Professional | | $1,318.26 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,398.83 / $3,311.31
| Professional | | $2,290.87 | $2,398.83 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Professional | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,089.30 / $2,818.38
| Professional | | $1,479.11 | $2,089.30 | $2,818.38 |