- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,466.84 / $5,495.41
| Facility | | $4,365.16 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,949.84 / $3,090.30
| Professional | | $1,380.38 | $1,949.84 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,309.57 / $9,549.93
| Facility | | $4,786.30 | $6,309.57 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,884.03 / $3,019.95
| Professional | | $2,454.71 | $2,884.03 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,995.26 / $2,630.27
| Professional | | $1,513.56 | $1,995.26 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,454.71 / $3,981.07
| Facility | | $1,479.11 | $2,454.71 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,570.40 / $3,388.44
| Professional | | $2,238.72 | $2,570.40 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,585.78 / $10,232.93
| Facility | | $6,165.95 | $7,585.78 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,951.21 / $3,235.94
| Professional | | $2,089.30 | $2,951.21 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,348.96 / $3,162.28
| Professional | | $1,230.27 | $1,348.96 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $10,232.93 / $27,542.29
| Facility | | $2,089.30 | $10,232.93 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,238.72 / $3,090.30
| Professional | | $1,513.56 | $2,238.72 | $3,090.30 |