- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,128.61 / $7,943.28
| Facility | | $2,818.38 | $5,128.61 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $5,495.41
| Professional | | $1,905.46 | $2,344.23 | $5,495.41 |
- 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
- $2,238.72 / $3,630.78 / $5,623.41
| Professional | | $2,238.72 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,890.45 / $4,897.79
| Professional | | $2,951.21 | $3,890.45 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,388.44 / $5,011.87
| Facility | | $1,995.26 | $3,388.44 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,801.89 / $5,248.07
| Professional | | $3,090.30 | $3,801.89 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,981.07 / $4,168.69
| Facility | | $3,235.94 | $3,981.07 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,311.31 / $5,011.87
| Facility | | $2,041.74 | $3,311.31 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $3,890.45 / $5,495.41
| Professional | | $79.43 | $3,890.45 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $16,595.87 / $26,915.35
| Facility | | $6,918.31 | $16,595.87 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,168.69 / $6,165.95
| Professional | | $3,630.78 | $4,168.69 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $17,378.01 / $26,302.68
| Facility | | $3,019.95 | $17,378.01 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,981.07 / $5,623.41
| Professional | | $2,818.38 | $3,981.07 | $5,623.41 |