- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,570.42 / $4,358.71 / $7,920.26
| Facility | | $3,570.42 | $4,358.71 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,609.16 / $2,449.88 / $6,428.05
| Professional | | $1,609.16 | $2,449.88 | $6,428.05 |
- 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
- $1,806.45 / $3,420.55 / $5,034.43
| Professional | | $1,806.45 | $3,420.55 | $5,034.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,841.45 / $3,731.09 / $4,559.63
| Professional | | $2,841.45 | $3,731.09 | $4,559.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.41 / $3,203.10 / $4,964.92
| Facility | | $2,044.41 | $3,203.10 | $4,964.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,675.40 / $3,195.79 / $5,343.84
| Professional | | $2,675.40 | $3,195.79 | $5,343.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,371.44 / $3,461.41 / $3,644.80
| Facility | | $2,371.44 | $3,461.41 | $3,644.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.41 / $3,629.11 / $4,964.92
| Facility | | $2,044.41 | $3,629.11 | $4,964.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,034.88 / $3,930.23 / $5,149.95
| Professional | | $3,034.88 | $3,930.23 | $5,149.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,357.11 / $9,357.11 / $9,357.11
| Facility | | $9,357.11 | $9,357.11 | $9,357.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,331.62 / $4,245.92 / $5,132.60
| Professional | | $3,331.62 | $4,245.92 | $5,132.60 |
- 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
- $2,687.20 / $3,885.27 / $5,653.86
| Professional | | $2,687.20 | $3,885.27 | $5,653.86 |