- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,073.80 / $7,943.28
| Facility | | $2,238.72 | $4,073.80 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,238.72 / $6,309.57
| Professional | | $1,659.59 | $2,238.72 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,548.13 / $5,011.87
| Professional | | $2,290.87 | $3,548.13 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $4,265.80
| Professional | | $1,584.89 | $3,467.37 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,511.89 / $5,888.44
| Facility | | $2,238.72 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $5,370.32
| Professional | | $2,630.27 | $3,311.31 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,235.94 / $3,388.44
| Facility | | $2,754.23 | $3,235.94 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,630.27 / $4,168.69
| Facility | | $1,905.46 | $2,630.27 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $3,162.28 / $4,677.35
| Professional | | $79.43 | $3,162.28 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $5,370.32
| Professional | | $3,090.30 | $3,981.07 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,232.93 / $37,153.52
| Facility | | $2,454.71 | $10,232.93 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,467.37 / $5,011.87
| Professional | | $2,187.76 | $3,467.37 | $5,011.87 |