- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,019.95 / $13,803.84
| Facility | | $2,344.23 | $3,019.95 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,318.26 / $2,951.21
| Professional | | $1,071.52 | $1,318.26 | $2,951.21 |
- 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
- $1,174.90 / $2,089.30 / $3,235.94
| Professional | | $1,174.90 | $2,089.30 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,290.87 / $2,818.38
| Professional | | $1,698.24 | $2,290.87 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,819.70 / $2,884.03
| Facility | | $1,148.15 | $1,819.70 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,089.30 / $3,019.95
| Professional | | $1,778.28 | $2,089.30 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,290.87 / $2,344.23
| Facility | | $1,819.70 | $2,290.87 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,819.70 / $2,511.89
| Facility | | $1,174.90 | $1,819.70 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $2,238.72 / $3,090.30
| Professional | | $79.43 | $2,238.72 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $16,595.87 / $26,915.35
| Facility | | $6,918.31 | $16,595.87 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,398.83 / $3,467.37
| Professional | | $2,089.30 | $2,398.83 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,892.96 / $31,622.78
| Facility | | $3,019.95 | $20,892.96 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,290.87 / $3,162.28
| Professional | | $1,548.82 | $2,290.87 | $3,162.28 |