- 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
- $758.58 / $1,096.48 / $1,737.80
| Professional | | $758.58 | $1,096.48 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,548.13 / $23,442.29
| Facility | | $2,238.72 | $3,548.13 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,659.59 / $1,698.24
| Professional | | $1,412.54 | $1,659.59 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,122.02 / $1,479.11
| Professional | | $851.14 | $1,122.02 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,380.38 / $2,187.76
| Facility | | $831.76 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,513.56 / $1,995.26
| Professional | | $1,318.26 | $1,513.56 | $1,995.26 |
- 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
- $14,791.08 / $18,620.87 / $24,547.09
| Facility | | $14,791.08 | $18,620.87 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,659.59 / $1,819.70
| Professional | | $1,174.90 | $1,659.59 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $776.25 / $1,819.70
| Professional | | $741.31 | $776.25 | $1,819.70 |
- 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
- $851.14 / $1,258.93 / $1,737.80
| Professional | | $851.14 | $1,258.93 | $1,737.80 |