- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $7,413.10 / $16,982.44
| Facility | | $1,737.80 | $7,413.10 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,230.27 / $2,344.23
| Professional | | $933.25 | $1,230.27 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $2,041.74
| Professional | | $1,071.52 | $1,445.44 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,819.70 / $16,595.87
| Professional | | $1,202.26 | $1,819.70 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $2,290.87
| Professional | | $1,000.00 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,174.90 / $2,951.21
| Professional | | $933.25 | $1,174.90 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $2,630.27
| Professional | | $1,548.82 | $1,949.84 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,513.56 / $2,187.76
| Facility | | $977.24 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $10,964.78
| Facility | | $1,047.13 | $1,513.56 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $10,964.78
| Professional | | $1,047.13 | $1,513.56 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,882.50 / $29,512.09
| Facility | | $8,317.64 | $12,882.50 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,412.54 / $2,290.87
| Professional | | $912.01 | $1,412.54 | $2,290.87 |