- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,453.51 / $2,889.57 / $4,797.13
| Facility | | $1,453.51 | $2,889.57 | $4,797.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.51 / $1,589.17 / $1,647.31
| Professional | | $1,453.51 | $1,589.17 | $1,647.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,360.56 / $9,438.11 / $11,918.76
| Facility | | $7,360.56 | $9,438.11 | $11,918.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.47 / $33.47 / $55.87
| Professional | | $33.47 | $33.47 | $55.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,550.41 / $1,744.21 / $3,401.21
| Professional | | $1,550.41 | $1,744.21 | $3,401.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,259.71 / $3,607.02 / $9,928.78
| Facility | | $1,259.71 | $3,607.02 | $9,928.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,360.51 / $2,360.51 / $2,828.16
| Professional | | $2,360.51 | $2,360.51 | $2,828.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,938.01 / $2,325.61 / $2,868.25
| Professional | | $1,938.01 | $2,325.61 | $2,868.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,540.72 / $1,938.01 / $3,294.62
| Facility | | $1,540.72 | $1,938.01 | $3,294.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,655.00 / $3,837.26 / $4,651.22
| Professional | | $2,655.00 | $3,837.26 | $4,651.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.61 / $2,203.52 / $3,598.11
| Facility | | $1,356.61 | $2,203.52 | $3,598.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,356.61 / $2,203.52 / $3,585.32
| Professional | | $1,356.61 | $2,203.52 | $3,585.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.96 / $1,007.77 / $2,519.41
| Professional | | $813.96 | $1,007.77 | $2,519.41 |