- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,311.31 / $14,454.40
| Facility | | $2,041.74 | $3,311.31 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $4,168.69
| Professional | | $1,548.82 | $2,041.74 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,964.78 / $18,197.01
| Facility | | $6,606.93 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,162.28 / $9,120.11
| Professional | | $1,621.81 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,786.30 / $7,762.47
| Facility | | $4,168.69 | $4,786.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,128.61 / $5,754.40
| Professional | | $2,818.38 | $5,128.61 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $7,413.10 / $14,454.40
| Facility | | $1,905.46 | $7,413.10 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,265.80 / $5,011.87
| Professional | | $3,467.37 | $4,265.80 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,388.44 / $9,549.93
| Facility | | $1,778.28 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,467.37 / $9,120.11
| Professional | | $2,041.74 | $3,467.37 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,344.23
| Professional | | $32.36 | $33.11 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,073.80 / $6,918.31
| Professional | | $2,884.03 | $4,073.80 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $30,902.95
| Facility | | $4,168.69 | $4,168.69 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $8,128.31 / $12,022.64
| Professional | | $2,818.38 | $8,128.31 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Professional | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $11,220.18 / $11,220.18
| Professional | | $7,762.47 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,467.37 / $7,413.10
| Professional | | $1,949.84 | $3,467.37 | $7,413.10 |