- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,467.37 / $7,943.28
| Facility | | $1,949.84 | $3,467.37 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,548.82 / $3,801.89
| Professional | | $1,258.93 | $1,548.82 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,454.71 / $3,801.89
| Professional | | $1,412.54 | $2,454.71 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,691.53 / $3,311.31
| Professional | | $1,995.26 | $2,691.53 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,089.30 / $3,388.44
| Facility | | $1,348.96 | $2,089.30 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,511.89 / $3,548.13
| Professional | | $2,089.30 | $2,511.89 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,691.53 / $2,818.38
| Facility | | $2,137.96 | $2,691.53 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,089.30 / $2,951.21
| Facility | | $1,380.38 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $2,630.27 / $3,715.35
| Professional | | $79.43 | $2,630.27 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $33,113.11 / $52,480.75
| Facility | | $13,489.63 | $33,113.11 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,818.38 / $4,168.69
| Professional | | $2,454.71 | $2,818.38 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,892.96 / $56,234.13
| Facility | | $3,019.95 | $20,892.96 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,691.53 / $3,715.35
| Professional | | $1,819.70 | $2,691.53 | $3,715.35 |