- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.99 / $5,509.26 / $7,462.23
| Facility | | $1,713.99 | $5,509.26 | $7,462.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,609.93 / $1,713.99 / $2,878.77
| Professional | | $1,609.93 | $1,713.99 | $2,878.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.34 / $2,829.72 / $7,666.44
| Facility | | $1,828.34 | $2,829.72 | $7,666.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.14 / $2,448.56 / $9,710.08
| Professional | | $1,469.14 | $2,448.56 | $9,710.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.56 / $3,501.44 / $6,567.04
| Facility | | $2,448.56 | $3,501.44 | $6,567.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,301.65 / $2,301.65 / $2,424.07
| Professional | | $2,301.65 | $2,301.65 | $2,424.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,575.33 / $1,769.15 / $5,570.46
| Facility | | $1,575.33 | $1,769.15 | $5,570.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.82 / $2,583.13 / $6,382.71
| Professional | | $1,271.82 | $2,583.13 | $6,382.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $5,585.00 / $13,471.99
| Facility | | $83.43 | $5,585.00 | $13,471.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,533.28 / $3,533.28 / $4,156.80
| Professional | | $3,533.28 | $3,533.28 | $4,156.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,448.56 / $2,448.56 / $7,582.95
| Professional | | $2,448.56 | $2,448.56 | $7,582.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,843.49 / $2,843.49 / $3,874.36
| Facility | | $2,843.49 | $2,843.49 | $3,874.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,260.49 / $11,630.66 / $11,630.66
| Facility | | $4,260.49 | $11,630.66 | $11,630.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,469.14 / $12,242.80
| Professional | | $1,028.40 | $1,469.14 | $12,242.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,469.14 / $4,284.97
| Professional | | $1,028.40 | $1,469.14 | $4,284.97 |