- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,623.41 / $8,128.31
| Facility | | $2,187.76 | $5,623.41 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,290.87 / $6,309.57
| Professional | | $1,698.24 | $2,290.87 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,548.13 / $8,709.64
| Facility | | $2,290.87 | $3,548.13 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,511.89 / $9,332.54
| Professional | | $1,513.56 | $2,511.89 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,165.95 / $8,912.51
| Facility | | $4,897.79 | $6,165.95 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,884.03 / $2,884.03
| Professional | | $2,454.71 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,454.71 / $5,248.07
| Facility | | $1,949.84 | $2,454.71 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,630.27 / $6,606.93
| Professional | | $1,513.56 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $5,888.44 / $17,782.79
| Facility | | $83.18 | $5,888.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $4,265.80
| Professional | | $3,630.78 | $3,630.78 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $5,370.32
| Professional | | $2,511.89 | $2,511.89 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,548.13 / $8,709.64
| Facility | | $2,290.87 | $3,548.13 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,511.89 / $9,332.54
| Professional | | $1,513.56 | $2,511.89 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,511.89 / $3,715.35
| Facility | | $1,862.09 | $2,511.89 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,511.89 / $5,011.87
| Professional | | $1,513.56 | $2,511.89 | $5,011.87 |