- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $8,709.64 / $15,135.61
| Facility | | $1,659.59 | $8,709.64 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,388.44 / $6,309.57
| Professional | | $2,884.03 | $3,388.44 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,248.07 / $8,317.64
| Professional | | $3,630.78 | $5,248.07 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $35,481.34
| Facility | | $489.78 | $575.44 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,786.30 / $8,128.31
| Professional | | $3,019.95 | $4,786.30 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,630.78 / $6,165.95
| Facility | | $2,884.03 | $3,630.78 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Professional | | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $5,888.44 / $7,943.28
| Professional | | $15.14 | $5,888.44 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,819.70 / $6,309.57
| Facility | | $309.03 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,630.78 / $6,309.57
| Professional | | $2,691.53 | $3,630.78 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $56,234.13 / $56,234.13
| Facility | | $2,818.38 | $56,234.13 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,387.21 / $22,387.21 / $26,915.35
| Professional | | $22,387.21 | $22,387.21 | $26,915.35 |