- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.42 / $3,668.51 / $7,920.26
| Facility | | $3,000.42 | $3,668.51 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.90 / $2,060.31 / $5,469.28
| Professional | | $1,355.90 | $2,060.31 | $5,469.28 |
- 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
- $1,519.77 / $2,872.96 / $4,232.05
| Professional | | $1,519.77 | $2,872.96 | $4,232.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,390.98 / $3,139.58 / $3,838.88
| Professional | | $2,390.98 | $3,139.58 | $3,838.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,604.33 / $2,695.29 / $4,164.27
| Facility | | $1,604.33 | $2,695.29 | $4,164.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,279.04 / $2,688.88 / $4,496.10
| Professional | | $2,279.04 | $2,688.88 | $4,496.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,988.62 / $2,905.12 / $3,066.59
| Facility | | $1,988.62 | $2,905.12 | $3,066.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,660.28 / $3,055.67 / $4,164.27
| Facility | | $1,660.28 | $3,055.67 | $4,164.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,546.82 / $3,303.83 / $4,329.14
| Professional | | $2,546.82 | $3,303.83 | $4,329.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,839.87 / $7,839.87 / $7,839.87
| Facility | | $7,839.87 | $7,839.87 | $7,839.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,802.07 / $3,572.35 / $4,316.81
| Professional | | $2,802.07 | $3,572.35 | $4,316.81 |
- 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
- $2,225.50 / $3,136.77 / $4,720.01
| Professional | | $2,225.50 | $3,136.77 | $4,720.01 |