- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,168.69 / $23,988.33
| Facility | | $3,235.94 | $4,168.69 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $4,466.84
| Professional | | $1,479.11 | $1,862.09 | $4,466.84 |
- 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
- $1,659.59 / $2,951.21 / $4,570.88
| Professional | | $1,659.59 | $2,951.21 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,162.28 / $3,890.45
| Professional | | $2,344.23 | $3,162.28 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,511.89 / $3,981.07
| Facility | | $1,621.81 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,951.21 / $4,265.80
| Professional | | $2,511.89 | $2,951.21 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $3,311.31
| Facility | | $2,398.83 | $3,162.28 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,511.89 / $3,548.13
| Facility | | $1,621.81 | $2,511.89 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $3,090.30 / $4,365.16
| Professional | | $79.43 | $3,090.30 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $42,657.95 / $67,608.30
| Facility | | $17,378.01 | $42,657.95 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,388.44 / $4,786.30
| Professional | | $2,951.21 | $3,388.44 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $26,302.68 / $56,234.13
| Facility | | $3,311.31 | $26,302.68 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $4,466.84
| Professional | | $2,137.96 | $3,162.28 | $4,466.84 |