- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,481.66 / $4,212.99 / $8,758.79
| Facility | | $2,481.66 | $4,212.99 | $8,758.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,043.72 / $2,364.88 / $2,744.42
| Professional | | $2,043.72 | $2,364.88 | $2,744.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $2,110.87 / $8,233.27
| Facility | | $92.60 | $2,110.87 | $8,233.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,415.93 / $4,087.44 / $5,167.68
| Facility | | $3,415.93 | $4,087.44 | $5,167.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,439.94 / $4,810.77 / $12,737.34
| Facility | | $1,439.94 | $4,810.77 | $12,737.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.83 / $1,167.83 / $2,855.36
| Professional | | $1,167.83 | $1,167.83 | $2,855.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.42 / $1,897.74 / $4,770.72
| Professional | | $1,328.42 | $1,897.74 | $4,770.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,751.76 / $1,751.76 / $2,481.66
| Professional | | $1,751.76 | $1,751.76 | $2,481.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,605.60 / $4,896.17 / $8,539.83
| Facility | | $2,605.60 | $4,896.17 | $8,539.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.35 / $3,556.09 / $4,260.59
| Professional | | $3,388.35 | $3,556.09 | $4,260.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.76 / $2,773.62 / $3,503.52
| Facility | | $1,751.76 | $2,773.62 | $3,503.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $3,357.54
| Professional | | $1,226.23 | $1,751.76 | $3,357.54 |