- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,754.40 / $8,511.38
| Facility | | $1,047.13 | $5,754.40 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $5,754.40
| Professional | | $1,905.46 | $2,344.23 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $21,379.62 / $57,543.99
| Facility | | $20,417.38 | $21,379.62 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,884.03 / $3,715.35
| Professional | | $1,698.24 | $2,884.03 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,630.27 / $3,890.45
| Professional | | $1,949.84 | $2,630.27 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $3,235.94
| Professional | | $2,884.03 | $2,884.03 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,754.23 / $4,466.84
| Professional | | $2,137.96 | $2,754.23 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,265.80 / $8,317.64
| Facility | | $1,023.29 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,511.89 / $6,165.95
| Professional | | $1,905.46 | $2,511.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $3,801.89 / $4,786.30
| Professional | | $25.12 | $3,801.89 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $2,041.74
| Facility | | $1,905.46 | $1,905.46 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,949.84 / $2,041.74
| Professional | | $1,819.70 | $1,949.84 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,570.40 / $6,760.83
| Facility | | $660.69 | $2,570.40 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,511.89 / $3,981.07
| Professional | | $1,862.09 | $2,511.89 | $3,981.07 |