- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,754.23 / $20,892.96
| Facility | | $1,819.70 | $2,754.23 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,202.26 / $2,754.23
| Professional | | $891.25 | $1,202.26 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,819.70 / $2,884.03
| Professional | | $1,174.90 | $1,819.70 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,995.26 / $2,454.71
| Facility | | $1,202.26 | $1,995.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,041.74 / $2,511.89
| Professional | | $1,230.27 | $2,041.74 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $61.66
| Professional | | $32.36 | $33.11 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,862.09 / $1,949.84
| Facility | | $1,621.81 | $1,862.09 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,348.96
| Facility | | $1,318.26 | $1,318.26 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,238.72 / $2,884.03
| Professional | | $1,348.96 | $2,238.72 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,949.84 / $2,511.89
| Professional | | $1,348.96 | $1,949.84 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,454.71 / $37,153.52
| Facility | | $707.95 | $2,454.71 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,584.89 / $2,818.38
| Professional | | $977.24 | $1,584.89 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,288.25 / $1,778.28
| Professional | | $954.99 | $1,288.25 | $1,778.28 |