- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $6,760.83 / $7,943.28
| Facility | | $3,801.89 | $6,760.83 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,951.21 / $7,413.10
| Professional | | $2,454.71 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,786.30 / $7,585.78
| Professional | | $2,754.23 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,248.07 / $6,456.54
| Professional | | $3,890.45 | $5,248.07 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,981.07 / $5,888.44
| Facility | | $2,570.40 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,570.88 / $7,079.46
| Professional | | $3,801.89 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,248.07 / $5,495.41
| Facility | | $3,890.45 | $5,248.07 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,981.07 / $5,754.40
| Facility | | $2,570.40 | $3,981.07 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $5,128.61 / $7,244.36
| Professional | | $79.43 | $5,128.61 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $42,657.95 / $67,608.30
| Facility | | $17,378.01 | $42,657.95 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,623.41 / $8,128.31
| Professional | | $4,265.80 | $5,623.41 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $26,302.68 / $75,857.76
| Facility | | $3,311.31 | $26,302.68 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,248.07 / $7,413.10
| Professional | | $3,388.44 | $5,248.07 | $7,413.10 |