- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,128.61 / $7,585.78
| Facility | | $2,238.72 | $5,128.61 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,041.74 / $2,630.27
| Professional | | $1,479.11 | $2,041.74 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $33.11 / $2,630.27
| Professional | | $33.11 | $33.11 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,801.89 / $9,772.37
| Facility | | $1,778.28 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $13,182.57 / $13,182.57
| Professional | | $2,691.53 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,466.84 / $10,471.29
| Facility | | $2,691.53 | $4,466.84 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,311.31 / $5,248.07
| Professional | | $1,905.46 | $3,311.31 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,691.53 / $4,786.30
| Professional | | $2,290.87 | $2,691.53 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,128.61 / $50,118.72
| Facility | | $3,548.13 | $5,128.61 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,818.38
| Professional | | $2,691.53 | $2,691.53 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,691.53 / $3,235.94
| Facility | | $2,454.71 | $2,691.53 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $3,548.13
| Professional | | $1,148.15 | $1,621.81 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,691.53 / $3,090.30
| Facility | | $2,290.87 | $2,691.53 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,691.53 / $5,370.32
| Professional | | $1,862.09 | $2,691.53 | $5,370.32 |