- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,042.94 / $3,705.12 / $7,920.26
| Facility | | $3,042.94 | $3,705.12 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.11 / $2,105.98 / $5,423.09
| Professional | | $1,320.11 | $2,105.98 | $5,423.09 |
- 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
- $1,507.89 / $2,883.12 / $4,278.47
| Professional | | $1,507.89 | $2,883.12 | $4,278.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,415.60 / $3,171.91 / $3,895.46
| Professional | | $2,415.60 | $3,171.91 | $3,895.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.83 / $2,723.04 / $4,016.18
| Facility | | $1,672.83 | $2,723.04 | $4,016.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,219.52 / $2,630.32 / $4,527.54
| Professional | | $2,219.52 | $2,630.32 | $4,527.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,890.71 / $2,777.15 / $3,088.03
| Facility | | $1,890.71 | $2,777.15 | $3,088.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.83 / $2,974.62 / $4,016.18
| Facility | | $1,672.83 | $2,974.62 | $4,016.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,514.05 / $3,312.27 / $4,356.33
| Professional | | $2,514.05 | $3,312.27 | $4,356.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,103.47 / $7,103.47 / $7,103.47
| Facility | | $7,103.47 | $7,103.47 | $7,103.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,826.06 / $3,597.32 / $4,353.76
| Professional | | $2,826.06 | $3,597.32 | $4,353.76 |
- 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
- $2,192.26 / $3,042.32 / $4,795.93
| Professional | | $2,192.26 | $3,042.32 | $4,795.93 |