- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $7,672.54 / $8,528.29
| Facility | | $5,116.62 | $7,672.54 | $8,528.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,156.92 / $4,783.38 / $13,185.10
| Professional | | $3,156.92 | $4,783.38 | $13,185.10 |
- 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
- $3,603.08 / $6,950.98 / $9,902.26
| Professional | | $3,603.08 | $6,950.98 | $9,902.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,540.35 / $7,274.98 / $8,825.14
| Professional | | $5,540.35 | $7,274.98 | $8,825.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,258.38 / $6,245.48 / $10,460.20
| Facility | | $3,258.38 | $6,245.48 | $10,460.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,612.40 / $6,518.06 / $10,483.37
| Professional | | $5,612.40 | $6,518.06 | $10,483.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,478.10 / $6,749.14 / $7,365.31
| Facility | | $4,478.10 | $6,749.14 | $7,365.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,332.31 / $7,217.39 / $10,460.20
| Facility | | $3,332.31 | $7,217.39 | $10,460.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,949.00 / $7,756.35 / $10,160.03
| Professional | | $5,949.00 | $7,756.35 | $10,160.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,079.78 / $19,079.78 / $19,079.78
| Facility | | $19,079.78 | $19,079.78 | $19,079.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,544.53 / $8,329.50 / $10,109.78
| Professional | | $6,544.53 | $8,329.50 | $10,109.78 |
- 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
- $5,165.58 / $7,553.37 / $11,320.96
| Professional | | $5,165.58 | $7,553.37 | $11,320.96 |