- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,077.43 / $3,765.89 / $7,920.26
| Facility | | $3,077.43 | $3,765.89 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,414.19 / $2,086.90 / $5,775.26
| Professional | | $1,414.19 | $2,086.90 | $5,775.26 |
- 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
- $1,545.76 / $2,972.11 / $4,305.50
| Professional | | $1,545.76 | $2,972.11 | $4,305.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,450.98 / $3,218.37 / $3,930.74
| Professional | | $2,450.98 | $3,218.37 | $3,930.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.98 / $2,779.32 / $4,322.55
| Facility | | $1,683.98 | $2,779.32 | $4,322.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,380.17 / $2,769.40 / $4,509.87
| Professional | | $2,380.17 | $2,769.40 | $4,509.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,033.44 / $2,985.74 / $3,124.60
| Facility | | $2,033.44 | $2,985.74 | $3,124.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,729.49 / $3,170.14 / $4,322.55
| Facility | | $1,729.49 | $3,170.14 | $4,322.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,612.12 / $3,321.77 / $4,306.84
| Professional | | $2,612.12 | $3,321.77 | $4,306.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,469.85 / $8,469.85 / $8,469.85
| Facility | | $8,469.85 | $8,469.85 | $8,469.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,810.69 / $3,580.99 / $4,330.08
| Professional | | $2,810.69 | $3,580.99 | $4,330.08 |
- 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
- $2,279.17 / $3,128.30 / $4,769.84
| Professional | | $2,279.17 | $3,128.30 | $4,769.84 |