- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.78 / $3,157.13 / $3,904.51
| Facility | | $2,630.78 | $3,157.13 | $3,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.81 / $1,894.94 / $4,054.74
| Professional | | $1,334.81 | $1,894.94 | $4,054.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,956.38 / $3,064.75 / $4,363.66
| Professional | | $1,956.38 | $3,064.75 | $4,363.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,540.87 / $3,261.85 / $3,842.98
| Professional | | $2,540.87 | $3,261.85 | $3,842.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.20 / $2,846.99 / $4,232.77
| Facility | | $1,828.20 | $2,846.99 | $4,232.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,255.40 / $2,810.61 / $4,029.96
| Professional | | $2,255.40 | $2,810.61 | $4,029.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,225.07 / $3,100.68 / $3,605.94
| Facility | | $2,225.07 | $3,100.68 | $3,605.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.20 / $2,897.28 / $4,232.77
| Facility | | $1,828.20 | $2,897.28 | $4,232.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,426.48 / $3,122.93 / $4,220.82
| Professional | | $2,426.48 | $3,122.93 | $4,220.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,382.73 / $9,721.75 / $12,751.18
| Facility | | $7,382.73 | $9,721.75 | $12,751.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,432.00 / $3,218.97 / $4,436.20
| Professional | | $2,432.00 | $3,218.97 | $4,436.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,268.00 / $24,231.00
| Facility | | $2,912.00 | $16,268.00 | $24,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,368.08 / $3,473.68 / $4,934.83
| Professional | | $2,368.08 | $3,473.68 | $4,934.83 |