- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,454.71 / $13,182.57
| Facility | | $1,819.70 | $2,454.71 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $912.01 / $2,398.83
| Professional | | $724.44 | $912.01 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,698.24 / $2,570.40
| Professional | | $1,023.29 | $1,698.24 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,778.28 / $2,089.30
| Professional | | $891.25 | $1,778.28 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,380.38 / $3,235.94
| Facility | | $912.01 | $1,380.38 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,621.81 / $2,398.83
| Professional | | $1,445.44 | $1,621.81 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,737.80 / $1,862.09
| Facility | | $1,288.25 | $1,737.80 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $2,290.87
| Facility | | $933.25 | $1,348.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,698.24 / $2,511.89
| Professional | | $79.43 | $1,698.24 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,912.51 / $10,715.19
| Facility | | $6,606.93 | $8,912.51 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,949.84 / $2,754.23
| Professional | | $1,348.96 | $1,949.84 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $9,549.93 / $12,882.50
| Facility | | $1,995.26 | $9,549.93 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,698.24 / $2,511.89
| Professional | | $1,047.13 | $1,698.24 | $2,511.89 |