- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,754.40 / $8,511.38
| Facility | | $1,047.13 | $5,754.40 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,905.46 / $2,951.21
| Professional | | $1,230.27 | $1,905.46 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,778.28 / $1,862.09
| Professional | | $851.14 | $1,778.28 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Facility | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,454.71 / $9,120.11
| Professional | | $2,238.72 | $2,454.71 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,691.53 / $3,981.07
| Professional | | $2,290.87 | $2,691.53 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $831.76
| Professional | | $489.78 | $489.78 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,265.80 / $8,317.64
| Facility | | $1,023.29 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,862.09 / $2,951.21
| Professional | | $1,174.90 | $1,862.09 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $457.09 / $1,737.80
| Facility | | $436.52 | $457.09 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $457.09 / $1,819.70
| Professional | | $436.52 | $457.09 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,981.07 / $22,387.21
| Facility | | $2,137.96 | $3,981.07 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,698.24 / $3,162.28
| Professional | | $501.19 | $1,698.24 | $3,162.28 |