- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,365.16 / $14,791.08
| Facility | | $1,995.26 | $4,365.16 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $2,344.23
| Professional | | $1,995.26 | $1,995.26 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,481.54 / $15,848.93
| Facility | | $7,244.36 | $11,481.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $812.83 / $1,288.25
| Professional | | $630.96 | $812.83 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $524.81 / $616.60
| Facility | | $489.78 | $524.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $691.83
| Professional | | $416.87 | $562.34 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,884.03 / $2,884.03
| Professional | | $2,344.23 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,089.30 / $3,715.35
| Facility | | $1,995.26 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,248.07 / $10,964.78
| Facility | | $1,737.80 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,248.07 / $10,964.78
| Professional | | $1,737.80 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,019.95 / $6,309.57
| Facility | | $407.38 | $3,019.95 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Professional | | $1,445.44 | $1,445.44 | $1,445.44 |