- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,621.81 / $3,090.30
| Professional | | $1,071.52 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,456.54 / $17,378.01
| Facility | | $2,511.89 | $6,456.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,511.89 / $2,570.40
| Professional | | $2,089.30 | $2,511.89 | $2,570.40 |
- 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
- $1,318.26 / $1,778.28 / $2,290.87
| Professional | | $1,318.26 | $1,778.28 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,041.74 / $3,801.89
| Facility | | $1,230.27 | $2,041.74 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,238.72 / $2,951.21
| Professional | | $1,949.84 | $2,238.72 | $2,951.21 |
- 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
- $1,778.28 / $2,511.89 / $2,754.23
| Professional | | $1,778.28 | $2,511.89 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,479.11 / $10,964.78
| Professional | | $1,071.52 | $1,479.11 | $10,964.78 |
- 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
- $1,174.90 / $1,819.70 / $2,570.40
| Professional | | $1,174.90 | $1,819.70 | $2,570.40 |