- 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
- $416.87 / $1,148.15 / $2,951.21
| Professional | | $416.87 | $1,148.15 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,981.07 / $8,317.64
| Facility | | $1,621.81 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,905.46 / $2,290.87
| Professional | | $691.83 | $1,905.46 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $2,511.89
| Professional | | $524.81 | $776.25 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,513.56 / $4,466.84
| Facility | | $501.19 | $1,513.56 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,819.70 / $2,691.53
| Professional | | $602.56 | $1,819.70 | $2,691.53 |
- 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
- $707.95 / $812.83 / $2,691.53
| Professional | | $707.95 | $812.83 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,230.27 / $6,918.31
| Professional | | $691.83 | $1,230.27 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $17,782.79 / $19,054.61
| Facility | | $9,332.54 | $17,782.79 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,071.52 / $2,398.83
| Professional | | $416.87 | $1,071.52 | $2,398.83 |