- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,943.28 / $14,454.40
| Facility | | $2,041.74 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,071.52 / $2,041.74
| Professional | | $954.99 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $20,892.96 / $40,738.03
| Facility | | $15,848.93 | $20,892.96 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,548.82 / $2,041.74
| Professional | | $912.01 | $1,548.82 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,905.46 / $3,311.31
| Professional | | $575.44 | $1,905.46 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,445.44 / $3,715.35
| Facility | | $933.25 | $1,445.44 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,089.30 / $7,585.78
| Professional | | $1,230.27 | $2,089.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,398.83 / $3,311.31
| Professional | | $1,949.84 | $2,398.83 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,238.72 / $3,311.31
| Professional | | $1,778.28 | $2,238.72 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $1,479.11 / $2,630.27
| Professional | | $6.03 | $1,479.11 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,584.89 / $2,754.23
| Professional | | $1,174.90 | $1,584.89 | $2,754.23 |