- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $9,198.17 / $21,218.22
| Facility | | $5,116.62 | $9,198.17 | $21,218.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,090.26 / $5,732.99 / $13,136.30
| Professional | | $4,090.26 | $5,732.99 | $13,136.30 |
- 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
- $4,311.22 / $8,325.52 / $11,881.21
| Professional | | $4,311.22 | $8,325.52 | $11,881.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,647.46 / $8,728.70 / $10,592.62
| Professional | | $6,647.46 | $8,728.70 | $10,592.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,842.69 / $7,493.50 / $12,544.66
| Facility | | $3,842.69 | $7,493.50 | $12,544.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,534.12 / $7,777.91 / $12,569.85
| Professional | | $6,534.12 | $7,777.91 | $12,569.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,774.33 / $8,097.81 / $8,673.40
| Facility | | $5,774.33 | $8,097.81 | $8,673.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,909.49 / $8,715.84 / $12,544.66
| Facility | | $3,909.49 | $8,715.84 | $12,544.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,138.06 / $9,277.10 / $12,170.78
| Professional | | $7,138.06 | $9,277.10 | $12,170.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,443.37 / $23,443.37 / $23,443.37
| Facility | | $23,443.37 | $23,443.37 | $23,443.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,844.71 / $9,987.28 / $12,128.47
| Professional | | $7,844.71 | $9,987.28 | $12,128.47 |
- 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
- $6,197.02 / $8,852.91 / $13,312.71
| Professional | | $6,197.02 | $8,852.91 | $13,312.71 |