- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,187.76 / $15,848.93
| Facility | | $1,737.80 | $2,187.76 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $954.99 / $1,949.84
| Professional | | $707.95 | $954.99 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,819.70 / $2,630.27
| Professional | | $954.99 | $1,819.70 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $2,089.30
| Professional | | $1,202.26 | $1,584.89 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $2,398.83
| Facility | | $933.25 | $1,348.96 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,513.56 / $2,238.72
| Professional | | $1,258.93 | $1,513.56 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,659.59 / $1,737.80
| Facility | | $1,288.25 | $1,659.59 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,230.27 / $2,041.74
| Facility | | $891.25 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,659.59 / $2,290.87
| Professional | | $79.43 | $1,659.59 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,772.37 / $11,748.98
| Facility | | $7,079.46 | $9,772.37 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,862.09 / $2,344.23
| Professional | | $1,621.81 | $1,862.09 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $9,772.37 / $14,125.38
| Facility | | $1,995.26 | $9,772.37 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,659.59 / $2,398.83
| Professional | | $1,096.48 | $1,659.59 | $2,398.83 |