- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $5,754.40 / $20,892.96
| Facility | | $2,951.21 | $5,754.40 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,754.23 / $6,456.54
| Professional | | $2,137.96 | $2,754.23 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $7,079.46
| Professional | | $2,884.03 | $4,466.84 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,897.79 / $6,025.60
| Facility | | $2,691.53 | $4,897.79 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,897.79 / $6,165.95
| Professional | | $2,884.03 | $4,897.79 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $75.86
| Professional | | $32.36 | $33.11 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,570.88 / $4,897.79
| Facility | | $3,548.13 | $4,570.88 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,311.31
| Facility | | $3,235.94 | $3,235.94 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,495.41 / $7,079.46
| Professional | | $3,311.31 | $5,495.41 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $6,309.57
| Professional | | $3,311.31 | $4,786.30 | $6,309.57 |
- 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
- $2,344.23 / $3,715.35 / $6,918.31
| Professional | | $2,344.23 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,090.30 / $4,365.16
| Professional | | $2,290.87 | $3,090.30 | $4,365.16 |