- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,248.07 / $7,943.28
| Facility | | $2,818.38 | $5,248.07 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,454.71 / $5,754.40
| Professional | | $1,905.46 | $2,454.71 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,801.89 / $5,888.44
| Professional | | $2,187.76 | $3,801.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,466.84 / $5,128.61
| Professional | | $3,311.31 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,162.28 / $5,128.61
| Facility | | $2,089.30 | $3,162.28 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,890.45 / $5,623.41
| Professional | | $3,162.28 | $3,890.45 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,168.69 / $4,466.84
| Facility | | $3,162.28 | $4,168.69 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,162.28 / $4,786.30
| Facility | | $2,041.74 | $3,162.28 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $4,073.80 / $5,888.44
| Professional | | $79.43 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,466.84 / $6,456.54
| Professional | | $3,630.78 | $4,466.84 | $6,456.54 |
- 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
- $2,884.03 / $4,265.80 / $5,888.44
| Professional | | $2,884.03 | $4,265.80 | $5,888.44 |