- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,715.35 / $12,882.50
| Facility | | $1,122.02 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,467.37 / $5,495.41
| Professional | | $2,818.38 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,890.45 / $5,370.32
| Professional | | $3,235.94 | $3,890.45 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $3,019.95 / $3,090.30
| Facility | | $79.43 | $3,019.95 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,365.16 / $6,760.83
| Professional | | $3,090.30 | $4,365.16 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $26,915.35
| Facility | | $54.95 | $56.23 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,547.09 / $28,840.32 / $28,840.32
| Professional | | $24,547.09 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,890.45 / $7,079.46
| Facility | | $2,511.89 | $3,890.45 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,073.80 / $5,495.41
| Professional | | $3,019.95 | $4,073.80 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $436.52 / $2,884.03
| Professional | | $32.36 | $436.52 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $6,456.54
| Professional | | $3,981.07 | $3,981.07 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,073.80 / $6,760.83
| Facility | | $3,090.30 | $4,073.80 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,365.16 / $7,079.46
| Professional | | $2,951.21 | $4,365.16 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $8,317.64 / $17,378.01
| Facility | | $2,630.27 | $8,317.64 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,467.37 / $5,248.07
| Professional | | $2,570.40 | $3,467.37 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,235.94 / $3,235.94
| Professional | | $2,951.21 | $3,235.94 | $3,235.94 |