- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,073.80 / $9,772.37
| Facility | | $2,511.89 | $4,073.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,691.53 / $6,918.31
| Professional | | $2,290.87 | $2,691.53 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,786.30 / $6,456.54
| Professional | | $2,951.21 | $4,786.30 | $6,456.54 |
- 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
- $2,630.27 / $3,548.13 / $6,309.57
| Professional | | $2,630.27 | $3,548.13 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $6,025.60
| Professional | | $4,365.16 | $4,365.16 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,388.44 / $5,248.07
| Facility | | $2,511.89 | $3,388.44 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,677.35 / $5,495.41
| Professional | | $3,801.89 | $4,677.35 | $5,495.41 |
- 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
- $2,187.76 / $2,884.03 / $5,128.61
| Professional | | $2,187.76 | $2,884.03 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $32,359.37 / $32,359.37
| Facility | | $5,011.87 | $32,359.37 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $23,442.29
| Professional | | $18,197.01 | $18,197.01 | $23,442.29 |