- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,521.44 / $3,174.16 / $7,920.26
| Facility | | $2,521.44 | $3,174.16 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.96 / $1,704.44 / $4,076.62
| Professional | | $1,140.96 | $1,704.44 | $4,076.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.27 / $2,445.23 / $3,914.84
| Professional | | $1,538.27 | $2,445.23 | $3,914.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,391.66 / $2,801.41 / $3,360.89
| Professional | | $2,391.66 | $2,801.41 | $3,360.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,595.64 / $2,270.25 / $3,095.01
| Facility | | $1,595.64 | $2,270.25 | $3,095.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,910.46 / $2,322.52 / $3,529.22
| Professional | | $1,910.46 | $2,322.52 | $3,529.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.23 / $2,237.80 / $2,694.07
| Facility | | $1,618.23 | $2,237.80 | $2,694.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,595.64 / $2,333.06 / $3,414.38
| Facility | | $1,595.64 | $2,333.06 | $3,414.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,190.21 / $2,660.16 / $3,660.68
| Professional | | $2,190.21 | $2,660.16 | $3,660.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,997.94 / $5,997.94 / $5,997.94
| Facility | | $5,997.94 | $5,997.94 | $5,997.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,447.82 / $3,138.39 / $4,218.03
| Professional | | $2,447.82 | $3,138.39 | $4,218.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $7,664.00 / $36,803.00
| Facility | | $2,364.00 | $7,664.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,805.75 / $2,633.40 / $3,936.18
| Professional | | $1,805.75 | $2,633.40 | $3,936.18 |