- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,168.69 / $7,943.28
| Facility | | $2,187.76 | $4,168.69 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,995.26 / $4,466.84
| Professional | | $1,513.56 | $1,995.26 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,467.37 / $5,128.61
| Professional | | $1,949.84 | $3,467.37 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,388.44 / $4,265.80
| Professional | | $2,570.40 | $3,388.44 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,511.89 / $4,677.35
| Facility | | $1,659.59 | $2,511.89 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,951.21 / $4,570.88
| Professional | | $2,570.40 | $2,951.21 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,235.94 / $3,467.37
| Facility | | $2,454.71 | $3,235.94 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,344.23 / $3,981.07
| Facility | | $1,659.59 | $2,344.23 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $3,235.94 / $4,570.88
| Professional | | $79.43 | $3,235.94 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $8,317.64
| Facility | | $8,317.64 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,630.78 / $4,677.35
| Professional | | $3,162.28 | $3,630.78 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,232.93 / $37,153.52
| Facility | | $2,454.71 | $10,232.93 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,311.31 / $4,677.35
| Professional | | $2,137.96 | $3,311.31 | $4,677.35 |