- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,310.34 / $5,256.87 / $9,044.37
| Facility | | $3,310.34 | $5,256.87 | $9,044.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,864.50 / $4,701.49 / $7,291.50
| Professional | | $3,864.50 | $4,701.49 | $7,291.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,412.42 / $4,083.24 / $5,162.38
| Facility | | $3,412.42 | $4,083.24 | $5,162.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,439.11 / $4,805.82 / $12,724.25
| Facility | | $1,439.11 | $4,805.82 | $12,724.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $2,108.69 / $8,224.81
| Facility | | $92.60 | $2,108.69 | $8,224.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.05 / $1,895.79 / $4,765.83
| Professional | | $1,327.05 | $1,895.79 | $4,765.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.83 / $1,167.83 / $2,853.86
| Professional | | $1,167.83 | $1,167.83 | $2,853.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,749.96 / $1,749.96 / $2,479.11
| Professional | | $1,749.96 | $1,749.96 | $2,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,602.92 / $4,891.14 / $8,531.06
| Facility | | $2,602.92 | $4,891.14 | $8,531.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,385.01 / $3,552.58 / $4,256.39
| Professional | | $3,385.01 | $3,552.58 | $4,256.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,624.94 / $2,624.94 / $3,499.92
| Facility | | $2,624.94 | $2,624.94 | $3,499.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.97 / $1,749.96 / $3,354.09
| Professional | | $1,224.97 | $1,749.96 | $3,354.09 |