- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,943.28 / $14,454.40
| Facility | | $2,344.23 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,659.59 / $7,585.78
| Professional | | $1,288.25 | $1,659.59 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $23,988.33 / $46,773.51
| Facility | | $18,620.87 | $23,988.33 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,137.96 / $2,818.38
| Professional | | $1,258.93 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,884.03 / $4,265.80
| Professional | | $1,737.80 | $2,884.03 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,454.71 / $26,915.35
| Facility | | $1,288.25 | $2,454.71 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,884.03 / $10,715.19
| Professional | | $1,737.80 | $2,884.03 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,311.31 / $4,466.84
| Professional | | $2,884.03 | $3,311.31 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Professional | | $2,691.53 | $2,691.53 | $2,691.53 |
- 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
- $1,949.84 / $2,754.23 / $3,715.35
| Professional | | $1,949.84 | $2,754.23 | $3,715.35 |