- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,814.15 / $3,883.48 / $6,324.52
| Facility | | $1,814.15 | $3,883.48 | $6,324.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,209.43 / $1,209.43 / $1,886.26
| Professional | | $1,209.43 | $1,209.43 | $1,886.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.66 / $1,549.20 / $3,728.23
| Professional | | $1,353.66 | $1,549.20 | $3,728.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,662.96 / $4,687.89 / $7,751.48
| Facility | | $2,662.96 | $4,687.89 | $7,751.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,549.86 / $3,187.33 / $10,696.21
| Professional | | $2,549.86 | $3,187.33 | $10,696.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $2,884.87 / $4,993.04
| Facility | | $319.00 | $2,884.87 | $4,993.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.65 / $1,309.29 / $4,149.77
| Professional | | $887.65 | $1,309.29 | $4,149.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,389.84 / $2,108.17 / $2,492.30
| Professional | | $1,389.84 | $2,108.17 | $2,492.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $4,687.89 / $7,988.29
| Facility | | $597.00 | $4,687.89 | $7,988.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,442.43 / $2,219.13 / $4,571.41
| Professional | | $1,442.43 | $2,219.13 | $4,571.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.03 / $1,248.28 / $3,259.30
| Professional | | $932.03 | $1,248.28 | $3,259.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,266.21 / $2,551.94 / $2,551.94
| Facility | | $2,266.21 | $2,551.94 | $2,551.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,389.84 / $2,108.17 / $2,667.21
| Professional | | $1,389.84 | $2,108.17 | $2,667.21 |