- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $7,943.28 / $14,454.40
| Facility | | $1,862.09 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,023.29 / $5,623.41
| Professional | | $954.99 | $1,023.29 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,471.29 / $20,417.38
| Facility | | $8,128.31 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,584.89 / $2,344.23
| Professional | | $933.25 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,398.83 / $3,162.28
| Professional | | $1,071.52 | $2,398.83 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,187.76 / $8,709.64
| Facility | | $1,047.13 | $2,187.76 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,137.96 / $7,943.28
| Professional | | $1,318.26 | $2,137.96 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,398.83 / $3,311.31
| Professional | | $2,344.23 | $2,398.83 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Professional | | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $1,621.81 / $2,691.53
| Professional | | $6.03 | $1,621.81 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,495.41 / $8,912.51
| Facility | | $2,754.23 | $5,495.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,995.26 / $2,630.27
| Professional | | $1,348.96 | $1,995.26 | $2,630.27 |