- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $5,495.41
| Facility | | $2,884.03 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $933.25 / $1,737.80
| Professional | | $758.58 | $933.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $8,912.51 / $18,620.87
| Facility | | $3,981.07 | $8,912.51 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,698.24 / $1,737.80
| Professional | | $1,445.44 | $1,698.24 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,174.90 / $1,479.11
| Professional | | $891.25 | $1,174.90 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,318.26 / $2,187.76
| Facility | | $812.83 | $1,318.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,621.81 / $2,187.76
| Professional | | $1,445.44 | $1,621.81 | $2,187.76 |
- 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
- $12,022.64 / $16,218.10 / $22,908.68
| Facility | | $12,022.64 | $16,218.10 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,698.24 / $2,041.74
| Professional | | $1,174.90 | $1,698.24 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,023.29 / $11,220.18
| Professional | | $776.25 | $1,023.29 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $11,748.98 / $29,512.09
| Facility | | $2,570.40 | $11,748.98 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,288.25 / $1,862.09
| Professional | | $912.01 | $1,288.25 | $1,862.09 |