- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,523.21 / $3,129.95 / $7,920.26
| Facility | | $2,523.21 | $3,129.95 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,134.58 / $1,751.23 / $4,485.99
| Professional | | $1,134.58 | $1,751.23 | $4,485.99 |
- 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
- $1,298.44 / $2,419.71 / $3,554.57
| Professional | | $1,298.44 | $2,419.71 | $3,554.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,047.24 / $2,688.21 / $3,311.06
| Professional | | $2,047.24 | $2,688.21 | $3,311.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,371.55 / $2,307.64 / $3,489.51
| Facility | | $1,371.55 | $2,307.64 | $3,489.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,901.97 / $2,262.00 / $3,817.32
| Professional | | $1,901.97 | $2,262.00 | $3,817.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,673.06 / $2,425.40 / $2,603.62
| Facility | | $1,673.06 | $2,425.40 | $2,603.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.09 / $2,543.59 / $3,489.51
| Facility | | $1,391.09 | $2,543.59 | $3,489.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,118.40 / $2,781.83 / $3,615.35
| Professional | | $2,118.40 | $2,781.83 | $3,615.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,524.94 / $6,524.94 / $6,524.94
| Facility | | $6,524.94 | $6,524.94 | $6,524.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,369.09 / $3,017.48 / $3,649.77
| Professional | | $2,369.09 | $3,017.48 | $3,649.77 |
- 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
- $1,782.24 / $2,599.11 / $3,990.65
| Professional | | $1,782.24 | $2,599.11 | $3,990.65 |