- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $7,943.28 / $16,595.87
| Facility | | $1,621.81 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $2,754.23
| Professional | | $1,174.90 | $1,445.44 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,584.89 / $2,344.23
| Professional | | $1,348.96 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $14,791.08 / $15,488.17
| Facility | | $2,344.23 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,737.80 / $3,311.31
| Professional | | $1,318.26 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $3,235.94
| Professional | | $2,344.23 | $2,344.23 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,778.28 / $2,951.21
| Facility | | $1,318.26 | $1,778.28 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $21,877.62 / $33,113.11
| Facility | | $6,606.93 | $21,877.62 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,380.38 / $2,290.87
| Professional | | $1,096.48 | $1,380.38 | $2,290.87 |