- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,168.69 / $21,877.62
| Facility | | $3,235.94 | $4,168.69 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,819.70 / $4,365.16
| Professional | | $1,479.11 | $1,819.70 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,884.03 / $4,466.84
| Professional | | $1,621.81 | $2,884.03 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $3,801.89
| Professional | | $2,398.83 | $3,162.28 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,454.71 / $4,073.80
| Facility | | $1,513.56 | $2,454.71 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,884.03 / $4,168.69
| Professional | | $2,398.83 | $2,884.03 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,090.30 / $3,235.94
| Facility | | $2,290.87 | $3,090.30 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,454.71 / $3,715.35
| Facility | | $1,584.89 | $2,454.71 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $3,090.30 / $4,265.80
| Professional | | $79.43 | $3,090.30 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,620.87 / $22,387.21
| Facility | | $13,803.84 | $18,620.87 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,311.31 / $4,677.35
| Professional | | $2,754.23 | $3,311.31 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,782.79 / $25,703.96
| Facility | | $2,884.03 | $17,782.79 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,090.30 / $4,365.16
| Professional | | $2,089.30 | $3,090.30 | $4,365.16 |