- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,722.94 / $4,533.18 / $7,920.26
| Facility | | $3,722.94 | $4,533.18 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.07 / $2,567.55 / $6,674.38
| Professional | | $1,670.07 | $2,567.55 | $6,674.38 |
- 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
- $1,874.35 / $3,544.82 / $5,238.75
| Professional | | $1,874.35 | $3,544.82 | $5,238.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,950.72 / $3,874.56 / $4,748.07
| Professional | | $2,950.72 | $3,874.56 | $4,748.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,051.33 / $3,326.26 / $5,137.08
| Facility | | $2,051.33 | $3,326.26 | $5,137.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,771.40 / $3,300.70 / $5,547.21
| Professional | | $2,771.40 | $3,300.70 | $5,547.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,505.80 / $3,579.81 / $3,783.49
| Facility | | $2,505.80 | $3,579.81 | $3,783.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,110.04 / $3,754.13 / $5,137.08
| Facility | | $2,110.04 | $3,754.13 | $5,137.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,115.52 / $4,079.96 / $5,352.43
| Professional | | $3,115.52 | $4,079.96 | $5,352.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,662.31 / $9,662.31 / $9,662.31
| Facility | | $9,662.31 | $9,662.31 | $9,662.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,460.77 / $4,407.47 / $5,331.58
| Professional | | $3,460.77 | $4,407.47 | $5,331.58 |
- 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
- $2,638.56 / $3,847.92 / $5,873.04
| Professional | | $2,638.56 | $3,847.92 | $5,873.04 |