- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,715.35 / $7,943.28
| Facility | | $2,238.72 | $3,715.35 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,737.80 / $3,981.07
| Professional | | $1,445.44 | $1,737.80 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,630.27 / $3,981.07
| Professional | | $1,122.02 | $2,630.27 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,951.21 / $3,548.13
| Professional | | $2,137.96 | $2,951.21 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,995.26 / $3,630.78
| Facility | | $1,513.56 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,884.03 / $3,801.89
| Professional | | $2,398.83 | $2,884.03 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,884.03 / $3,162.28
| Facility | | $2,511.89 | $2,884.03 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,238.72 / $3,715.35
| Facility | | $1,445.44 | $2,238.72 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $3,090.30 / $4,168.69
| Professional | | $79.43 | $3,090.30 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Facility | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,235.94 / $4,073.80
| Professional | | $2,884.03 | $3,235.94 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,585.78 / $31,622.78
| Facility | | $1,412.54 | $7,585.78 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,090.30 / $4,365.16
| Professional | | $2,041.74 | $3,090.30 | $4,365.16 |