- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,943.28 / $14,454.40
| Facility | | $1,995.26 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,412.54 / $5,623.41
| Professional | | $977.24 | $1,412.54 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $14,454.40 / $28,183.83
| Facility | | $10,964.78 | $14,454.40 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,584.89 / $2,137.96
| Professional | | $933.25 | $1,584.89 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,454.71 / $3,311.31
| Professional | | $1,479.11 | $2,454.71 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,995.26 / $11,481.54
| Facility | | $1,258.93 | $1,995.26 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,238.72 / $11,748.98
| Professional | | $1,348.96 | $2,238.72 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,511.89 / $3,467.37
| Professional | | $2,454.71 | $2,511.89 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Professional | | $2,290.87 | $2,290.87 | $2,290.87 |
- 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
- $1,548.82 / $2,137.96 / $2,884.03
| Professional | | $1,548.82 | $2,137.96 | $2,884.03 |