- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,251.72 / $7,920.26 / $23,718.90
| Facility | | $4,251.72 | $7,920.26 | $23,718.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,912.24 / $2,932.48 / $7,598.81
| Professional | | $1,912.24 | $2,932.48 | $7,598.81 |
- 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
- $2,132.33 / $4,063.84 / $5,966.85
| Professional | | $2,132.33 | $4,063.84 | $5,966.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,356.47 / $4,407.35 / $5,399.94
| Professional | | $3,356.47 | $4,407.35 | $5,399.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,286.52 / $3,783.66 / $5,860.90
| Facility | | $2,286.52 | $3,783.66 | $5,860.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,154.80 / $3,777.00 / $6,315.36
| Professional | | $3,154.80 | $3,777.00 | $6,315.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,783.70 / $4,088.79 / $4,307.43
| Facility | | $2,783.70 | $4,088.79 | $4,307.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.10 / $4,297.45 / $5,860.90
| Facility | | $2,321.10 | $4,297.45 | $5,860.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,583.55 / $4,658.13 / $6,103.75
| Professional | | $3,583.55 | $4,658.13 | $6,103.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,016.29 / $11,016.29 / $11,016.29
| Facility | | $11,016.29 | $11,016.29 | $11,016.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,941.11 / $5,017.83 / $6,071.58
| Professional | | $3,941.11 | $5,017.83 | $6,071.58 |
- 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
- $3,084.55 / $4,406.51 / $6,688.19
| Professional | | $3,084.55 | $4,406.51 | $6,688.19 |