- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.13 / $3,297.53 / $6,038.88
| Facility | | $2,003.13 | $3,297.53 | $6,038.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.85 / $1,758.68 / $1,912.56
| Professional | | $1,538.85 | $1,758.68 | $1,912.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.46 / $3,226.08 / $8,573.57
| Facility | | $714.46 | $3,226.08 | $8,573.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $1,589.41 / $6,199.35
| Facility | | $92.60 | $1,589.41 | $6,199.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,572.06 / $3,077.69 / $3,891.07
| Facility | | $2,572.06 | $3,077.69 | $3,891.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,198.35 / $2,198.35 / $2,198.35
| Professional | | $2,198.35 | $2,198.35 | $2,198.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.79 / $571.41 / $1,960.95
| Professional | | $514.79 | $571.41 | $1,960.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.25 / $1,428.93 / $3,573.04
| Professional | | $1,000.25 | $1,428.93 | $3,573.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.01 / $1,319.01 / $1,868.60
| Professional | | $1,319.01 | $1,319.01 | $1,868.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,571.27 / $3,409.99 / $6,747.16
| Facility | | $1,571.27 | $3,409.99 | $6,747.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,677.46 / $2,677.46 / $3,207.90
| Professional | | $2,677.46 | $2,677.46 | $3,207.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,978.52 / $1,978.52 / $1,978.52
| Facility | | $1,978.52 | $1,978.52 | $1,978.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.31 / $1,319.01 / $2,528.10
| Professional | | $923.31 | $1,319.01 | $2,528.10 |