- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.23 / $3,851.88 / $7,920.26
| Facility | | $3,146.23 | $3,851.88 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,413.98 / $2,165.14 / $4,947.02
| Professional | | $1,413.98 | $2,165.14 | $4,947.02 |
- 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
- $1,595.55 / $3,019.96 / $4,437.29
| Professional | | $1,595.55 | $3,019.96 | $4,437.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.23 / $3,297.47 / $4,037.50
| Professional | | $2,511.23 | $3,297.47 | $4,037.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,798.80 / $2,830.92 / $4,322.55
| Facility | | $1,798.80 | $2,830.92 | $4,322.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,388.33 / $2,802.00 / $4,716.14
| Professional | | $2,388.33 | $2,802.00 | $4,716.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,199.48 / $3,045.82 / $3,216.67
| Facility | | $2,199.48 | $3,045.82 | $3,216.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,798.80 / $3,174.77 / $4,322.55
| Facility | | $1,798.80 | $3,174.77 | $4,322.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,655.36 / $3,464.05 / $4,532.57
| Professional | | $2,655.36 | $3,464.05 | $4,532.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,726.32 / $7,726.32 / $7,726.32
| Facility | | $7,726.32 | $7,726.32 | $7,726.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,938.62 / $3,747.18 / $4,527.16
| Professional | | $2,938.62 | $3,747.18 | $4,527.16 |
- 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
- $2,240.46 / $3,174.71 / $4,950.00
| Professional | | $2,240.46 | $3,174.71 | $4,950.00 |