- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $5,495.41
| Facility | | $4,466.84 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,258.93 / $2,884.03
| Professional | | $1,047.13 | $1,258.93 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,025.60 / $9,549.93
| Facility | | $3,235.94 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,819.70 / $1,862.09
| Professional | | $1,548.82 | $1,819.70 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,621.81 / $1,949.84
| Professional | | $1,318.26 | $1,621.81 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,949.84 / $4,466.84
| Facility | | $1,202.26 | $1,949.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,698.24 / $2,089.30
| Professional | | $1,479.11 | $1,698.24 | $2,089.30 |
- 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
- $5,754.40 / $7,244.36 / $10,471.29
| Facility | | $5,754.40 | $7,244.36 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,905.46 / $2,041.74
| Professional | | $1,778.28 | $1,905.46 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,445.44 / $7,943.28
| Professional | | $812.83 | $1,445.44 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $16,982.44 / $18,197.01
| Facility | | $9,332.54 | $16,982.44 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,479.11 / $2,238.72
| Professional | | $1,047.13 | $1,479.11 | $2,238.72 |