- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $9,672.53 / $11,672.90
| Facility | | $5,116.62 | $9,672.53 | $11,672.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,319.87 / $6,546.93 / $18,202.20
| Professional | | $4,319.87 | $6,546.93 | $18,202.20 |
- 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
- $4,934.80 / $9,546.59 / $13,656.05
| Professional | | $4,934.80 | $9,546.59 | $13,656.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,582.07 / $9,955.94 / $12,066.00
| Professional | | $7,582.07 | $9,955.94 | $12,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.60 / $8,547.06 / $14,669.83
| Facility | | $4,365.60 | $8,547.06 | $14,669.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,758.40 / $8,976.00 / $14,356.68
| Professional | | $7,758.40 | $8,976.00 | $14,356.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,853.95 / $9,236.34 / $10,200.08
| Facility | | $6,853.95 | $9,236.34 | $10,200.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,459.14 / $9,984.31 / $14,669.83
| Facility | | $4,459.14 | $9,984.31 | $14,669.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,140.02 / $10,668.95 / $13,930.67
| Professional | | $8,140.02 | $10,668.95 | $13,930.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,071.45 / $26,071.45 / $26,071.45
| Facility | | $26,071.45 | $26,071.45 | $26,071.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,967.14 / $11,407.01 / $13,911.25
| Professional | | $8,967.14 | $11,407.01 | $13,911.25 |
- 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
- $7,367.22 / $10,357.09 / $15,367.31
| Professional | | $7,367.22 | $10,357.09 | $15,367.31 |