- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $7,382.19 / $8,188.08
| Facility | | $5,116.62 | $7,382.19 | $8,188.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,879.81 / $4,622.41 / $10,516.10
| Professional | | $2,879.81 | $4,622.41 | $10,516.10 |
- 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
- $2,956.74 / $6,380.91 / $9,553.70
| Professional | | $2,956.74 | $6,380.91 | $9,553.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,247.47 / $6,890.40 / $8,373.12
| Professional | | $5,247.47 | $6,890.40 | $8,373.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,457.26 / $5,379.27 / $8,332.54
| Facility | | $3,457.26 | $5,379.27 | $8,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,209.60 / $5,726.30 / $10,035.45
| Professional | | $4,209.60 | $5,726.30 | $10,035.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,796.54 / $5,545.44 / $6,844.72
| Facility | | $3,796.54 | $5,545.44 | $6,844.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,596.99 / $5,653.90 / $8,774.93
| Facility | | $3,596.99 | $5,653.90 | $8,774.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,086.84 / $7,350.48 / $9,698.54
| Professional | | $5,086.84 | $7,350.48 | $9,698.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,930.09 / $13,930.09 / $13,930.09
| Facility | | $13,930.09 | $13,930.09 | $13,930.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,288.68 / $7,973.59 / $9,688.19
| Professional | | $6,288.68 | $7,973.59 | $9,688.19 |
- 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
- $4,394.31 / $6,683.81 / $10,672.11
| Professional | | $4,394.31 | $6,683.81 | $10,672.11 |