- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,817.02 / $3,431.13 / $7,920.26
| Facility | | $2,817.02 | $3,431.13 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.89 / $1,924.65 / $5,674.33
| Professional | | $1,272.89 | $1,924.65 | $5,674.33 |
- 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
- $1,436.43 / $2,758.93 / $3,946.94
| Professional | | $1,436.43 | $2,758.93 | $3,946.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,233.00 / $2,932.14 / $3,575.91
| Professional | | $2,233.00 | $2,932.14 | $3,575.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,507.90 / $2,633.04 / $3,966.20
| Facility | | $1,507.90 | $2,633.04 | $3,966.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,178.21 / $2,584.06 / $4,203.35
| Professional | | $2,178.21 | $2,584.06 | $4,203.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,914.43 / $2,720.21 / $2,866.93
| Facility | | $1,914.43 | $2,720.21 | $2,866.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,652.80 / $2,923.92 / $3,966.20
| Facility | | $1,652.80 | $2,923.92 | $3,966.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,399.62 / $3,088.76 / $4,044.15
| Professional | | $2,399.62 | $3,088.76 | $4,044.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,435.29 / $7,435.29 / $7,435.29
| Facility | | $7,435.29 | $7,435.29 | $7,435.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,618.17 / $3,339.76 / $4,033.51
| Professional | | $2,618.17 | $3,339.76 | $4,033.51 |
- 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
- $2,045.26 / $3,015.71 / $4,529.02
| Professional | | $2,045.26 | $3,015.71 | $4,529.02 |