- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,709.64 / $10,715.19
| Facility | | $6,456.54 | $8,709.64 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,011.87 / $11,481.54
| Professional | | $3,981.07 | $5,011.87 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,413.10 / $11,220.18
| Professional | | $1,412.54 | $7,413.10 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,317.64 / $10,000.00
| Professional | | $6,025.60 | $8,317.64 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,888.44 / $10,471.29
| Facility | | $3,890.45 | $5,888.44 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,128.31 / $10,715.19
| Professional | | $6,456.54 | $8,128.31 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,317.64 / $8,912.51
| Facility | | $6,606.93 | $8,317.64 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,888.44 / $10,000.00
| Facility | | $3,630.78 | $5,888.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $8,709.64 / $11,748.98
| Professional | | $79.43 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,442.29 / $23,442.29
| Facility | | $23,442.29 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $9,332.54 / $11,748.98
| Professional | | $8,317.64 | $9,332.54 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,585.78 / $31,622.78
| Facility | | $1,412.54 | $7,585.78 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $8,709.64 / $12,589.25
| Professional | | $4,677.35 | $8,709.64 | $12,589.25 |