- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,696.65 / $4,497.82 / $7,920.26
| Facility | | $3,696.65 | $4,497.82 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.83 / $2,541.33 / $6,691.81
| Professional | | $1,669.83 | $2,541.33 | $6,691.81 |
- 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
- $1,861.72 / $3,533.11 / $5,202.53
| Professional | | $1,861.72 | $3,533.11 | $5,202.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,929.05 / $3,846.11 / $4,704.25
| Professional | | $2,929.05 | $3,846.11 | $4,704.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.85 / $3,301.84 / $5,075.99
| Facility | | $2,003.85 | $3,301.84 | $5,075.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,824.38 / $3,306.81 / $5,510.85
| Professional | | $2,824.38 | $3,306.81 | $5,510.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.90 / $3,555.69 / $3,758.70
| Facility | | $2,446.90 | $3,555.69 | $3,758.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,026.99 / $3,734.68 / $5,075.99
| Facility | | $2,026.99 | $3,734.68 | $5,075.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,132.80 / $4,061.45 / $5,321.90
| Professional | | $3,132.80 | $4,061.45 | $5,321.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,571.81 / $9,571.81 / $9,571.81
| Facility | | $9,571.81 | $9,571.81 | $9,571.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,438.63 / $4,378.60 / $5,297.47
| Professional | | $3,438.63 | $4,378.60 | $5,297.47 |
- 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
- $2,740.00 / $3,829.73 / $5,792.26
| Professional | | $2,740.00 | $3,829.73 | $5,792.26 |