- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,466.84 / $15,848.93
| Facility | | $3,467.37 | $4,466.84 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,995.26 / $4,365.16
| Professional | | $1,584.89 | $1,995.26 | $4,365.16 |
- 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
- $1,778.28 / $3,090.30 / $4,897.79
| Professional | | $1,778.28 | $3,090.30 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,388.44 / $4,168.69
| Professional | | $2,570.40 | $3,388.44 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,454.71 / $4,265.80
| Facility | | $1,548.82 | $2,454.71 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,162.28 / $4,570.88
| Professional | | $1,819.70 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,467.37 / $3,548.13
| Facility | | $2,290.87 | $3,467.37 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,398.83 / $3,715.35
| Facility | | $1,479.11 | $2,398.83 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $3,311.31 / $4,677.35
| Professional | | $79.43 | $3,311.31 | $4,677.35 |
- 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
- $2,398.83 / $3,630.78 / $5,248.07
| Professional | | $2,398.83 | $3,630.78 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $17,378.01 / $26,302.68
| Facility | | $3,019.95 | $17,378.01 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,388.44 / $4,786.30
| Professional | | $2,238.72 | $3,388.44 | $4,786.30 |