- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,847.72 / $3,478.53 / $7,920.26
| Facility | | $2,847.72 | $3,478.53 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.86 / $1,950.79 / $5,532.34
| Professional | | $1,291.86 | $1,950.79 | $5,532.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.70 / $1,664.70 / $1,664.70
| Facility | | $1,664.70 | $1,664.70 | $1,664.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.98 / $2,747.59 / $3,992.45
| Professional | | $1,461.98 | $2,747.59 | $3,992.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,265.00 / $2,974.16 / $3,633.49
| Professional | | $2,265.00 | $2,974.16 | $3,633.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,501.76 / $2,588.88 / $4,001.37
| Facility | | $1,501.76 | $2,588.88 | $4,001.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,199.12 / $2,604.28 / $4,257.39
| Professional | | $2,199.12 | $2,604.28 | $4,257.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.90 / $2,759.18 / $2,939.64
| Facility | | $1,866.90 | $2,759.18 | $2,939.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,622.10 / $2,930.60 / $4,001.37
| Facility | | $1,622.10 | $2,930.60 | $4,001.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,427.56 / $3,131.32 / $4,090.44
| Professional | | $2,427.56 | $3,131.32 | $4,090.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,541.75 / $7,541.75 / $7,541.75
| Facility | | $7,541.75 | $7,541.75 | $7,541.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,650.17 / $3,382.69 / $4,082.78
| Professional | | $2,650.17 | $3,382.69 | $4,082.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.00 / $7,664.00 / $31,303.00
| Facility | | $1,345.00 | $7,664.00 | $31,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,147.61 / $3,131.51 / $4,497.42
| Professional | | $2,147.61 | $3,131.51 | $4,497.42 |