- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,943.28 / $8,709.64
| Facility | | $5,248.07 | $7,943.28 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,073.80 / $9,332.54
| Professional | | $3,235.94 | $4,073.80 | $9,332.54 |
- 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 / $6,165.95 / $9,120.11
| Professional | | $1,412.54 | $6,165.95 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,760.83 / $8,128.31
| Professional | | $5,011.87 | $6,760.83 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $8,511.38
| Facility | | $3,311.31 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,606.93 / $8,709.64
| Professional | | $5,370.32 | $6,606.93 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,760.83 / $7,413.10
| Facility | | $5,370.32 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,786.30 / $8,128.31
| Facility | | $3,162.28 | $4,786.30 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $7,079.46 / $9,549.93
| Professional | | $79.43 | $7,079.46 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $19,054.61
| Facility | | $19,054.61 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $7,585.78 / $9,549.93
| Professional | | $6,760.83 | $7,585.78 | $9,549.93 |
- 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
- $3,890.45 / $7,079.46 / $10,232.93
| Professional | | $3,890.45 | $7,079.46 | $10,232.93 |