- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,466.84 / $5,495.41
| Facility | | $1,621.81 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,513.56 / $2,344.23
| Professional | | $1,023.29 | $1,513.56 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,570.88 / $8,511.38
| Facility | | $2,137.96 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,187.76 / $2,290.87
| Professional | | $1,905.46 | $2,187.76 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $1,995.26
| Professional | | $1,202.26 | $1,584.89 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $3,019.95
| Facility | | $1,096.48 | $1,737.80 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,238.72 / $2,884.03
| Professional | | $1,949.84 | $2,238.72 | $2,884.03 |
- 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
- $5,888.44 / $7,244.36 / $10,232.93
| Facility | | $5,888.44 | $7,244.36 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $2,511.89
| Professional | | $1,548.82 | $2,187.76 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,380.38 / $6,025.60
| Professional | | $1,071.52 | $1,380.38 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $9,332.54 / $18,197.01
| Facility | | $1,513.56 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,737.80 / $2,398.83
| Professional | | $1,202.26 | $1,737.80 | $2,398.83 |