- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,428.21 / $4,173.58 / $7,920.26
| Facility | | $3,428.21 | $4,173.58 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,566.79 / $2,246.26 / $5,360.19
| Professional | | $1,566.79 | $2,246.26 | $5,360.19 |
- 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
- $1,725.83 / $3,272.05 / $4,825.47
| Professional | | $1,725.83 | $3,272.05 | $4,825.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,715.92 / $3,566.25 / $4,364.85
| Professional | | $2,715.92 | $3,566.25 | $4,364.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,891.17 / $3,061.58 / $4,737.22
| Facility | | $1,891.17 | $3,061.58 | $4,737.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,611.19 / $3,050.40 / $5,112.03
| Professional | | $2,611.19 | $3,050.40 | $5,112.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,396.82 / $3,303.10 / $3,486.68
| Facility | | $2,396.82 | $3,303.10 | $3,486.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,948.34 / $3,514.02 / $4,737.22
| Facility | | $1,948.34 | $3,514.02 | $4,737.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,899.12 / $3,759.89 / $4,936.20
| Professional | | $2,899.12 | $3,759.89 | $4,936.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,730.69 / $8,730.69 / $8,730.69
| Facility | | $8,730.69 | $8,730.69 | $8,730.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,189.55 / $4,061.72 / $4,913.72
| Professional | | $3,189.55 | $4,061.72 | $4,913.72 |
- 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
- $2,508.83 / $3,466.65 / $5,412.76
| Professional | | $2,508.83 | $3,466.65 | $5,412.76 |