- 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
- $1,202.26 / $1,412.54 / $3,630.78
| Professional | | $1,202.26 | $1,412.54 | $3,630.78 |
- 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
- $1,047.13 / $1,778.28 / $2,398.83
| Professional | | $1,047.13 | $1,778.28 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $2,398.83
| Professional | | $1,202.26 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,949.84
| Professional | | $1,698.24 | $1,698.24 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,659.59 / $2,691.53
| Professional | | $1,288.25 | $1,659.59 | $2,691.53 |
- 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
- $1,230.27 / $1,548.82 / $3,715.35
| Professional | | $1,230.27 | $1,548.82 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $2,398.83 / $2,884.03
| Professional | | $7.94 | $2,398.83 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,318.26
| Facility | | $1,148.15 | $1,148.15 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,174.90 / $1,318.26
| Professional | | $1,096.48 | $1,174.90 | $1,318.26 |
- 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
- $1,148.15 / $1,548.82 / $2,454.71
| Professional | | $1,148.15 | $1,548.82 | $2,454.71 |