- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,807.27 / $7,441.70 / $8,892.33
| Facility | | $1,807.27 | $7,441.70 | $8,892.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.72 / $1,722.22 / $2,807.22
| Professional | | $1,275.72 | $1,722.22 | $2,807.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,658.44 / $1,658.44 / $1,658.44
| Professional | | $1,658.44 | $1,658.44 | $1,658.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,423.49 / $2,762.40 / $6,353.19
| Facility | | $1,423.49 | $2,762.40 | $6,353.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,248.28 / $10,248.28 / $10,248.28
| Professional | | $10,248.28 | $10,248.28 | $10,248.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,232.51 / $2,870.37 / $5,251.71
| Professional | | $2,232.51 | $2,870.37 | $5,251.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.52 / $7,336.66 / $8,892.33
| Facility | | $2,367.52 | $7,336.66 | $8,892.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.82 / $1,807.27 / $8,781.20
| Professional | | $1,445.82 | $1,807.27 | $8,781.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,146.78 / $3,189.30 / $4,252.39
| Professional | | $3,146.78 | $3,189.30 | $4,252.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.54 / $2,686.58 / $7,055.32
| Facility | | $1,481.54 | $2,686.58 | $7,055.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,248.28 / $10,248.28 / $10,248.28
| Professional | | $10,248.28 | $10,248.28 | $10,248.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.19 / $2,126.19 / $2,338.82
| Facility | | $2,126.19 | $2,126.19 | $2,338.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,126.19 / $2,126.19 / $2,338.82
| Professional | | $2,126.19 | $2,126.19 | $2,338.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.00 / $1,275.72 / $2,657.75
| Professional | | $893.00 | $1,275.72 | $2,657.75 |