- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,884.03 / $8,709.64
| Facility | | $1,819.70 | $2,884.03 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,949.84 / $4,786.30
| Professional | | $1,659.59 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,630.27 / $4,570.88
| Professional | | $2,041.74 | $2,630.27 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $15,488.17
| Facility | | $602.56 | $602.56 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,511.89 / $4,466.84
| Professional | | $1,862.09 | $2,511.89 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $4,365.16
| Professional | | $2,951.21 | $2,951.21 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,398.83 / $3,630.78
| Facility | | $1,819.70 | $2,398.83 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,388.44 / $3,981.07
| Professional | | $2,754.23 | $3,388.44 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,890.45 / $6,918.31
| Facility | | $1,047.13 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $3,630.78
| Professional | | $1,548.82 | $2,041.74 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $19,054.61 / $19,054.61
| Facility | | $5,011.87 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $16,982.44
| Professional | | $13,182.57 | $13,182.57 | $16,982.44 |