- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $5,495.41
| Facility | | $2,884.03 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,023.29 / $1,949.84
| Professional | | $741.31 | $1,023.29 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,248.07 / $17,378.01
| Facility | | $1,949.84 | $5,248.07 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,584.89 / $1,621.81
| Professional | | $1,348.96 | $1,584.89 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $1,412.54
| Professional | | $812.83 | $1,122.02 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,318.26 / $2,454.71
| Facility | | $776.25 | $1,318.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,412.54 / $1,905.46
| Professional | | $1,258.93 | $1,412.54 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $15,135.61 / $21,379.62
| Facility | | $10,964.78 | $15,135.61 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,584.89 / $1,949.84
| Professional | | $1,122.02 | $1,584.89 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $933.25 / $10,232.93
| Professional | | $691.83 | $933.25 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $10,232.93 / $27,542.29
| Facility | | $2,089.30 | $10,232.93 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $1,659.59
| Professional | | $812.83 | $1,202.26 | $1,659.59 |