- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $6,064.02 / $7,920.26
| Facility | | $5,116.62 | $6,064.02 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,499.80 / $3,784.84 / $10,536.80
| Professional | | $2,499.80 | $3,784.84 | $10,536.80 |
- 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
- $2,836.24 / $5,397.84 / $7,796.37
| Professional | | $2,836.24 | $5,397.84 | $7,796.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,390.33 / $5,764.90 / $7,009.70
| Professional | | $4,390.33 | $5,764.90 | $7,009.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.92 / $4,949.09 / $7,942.57
| Facility | | $2,699.92 | $4,949.09 | $7,942.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,352.85 / $5,089.91 / $8,289.84
| Professional | | $4,352.85 | $5,089.91 | $8,289.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,797.06 / $5,348.22 / $5,654.13
| Facility | | $3,797.06 | $5,348.22 | $5,654.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,700.40 / $5,680.47 / $7,942.57
| Facility | | $2,700.40 | $5,680.47 | $7,942.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,715.74 / $6,097.18 / $7,980.95
| Professional | | $4,715.74 | $6,097.18 | $7,980.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,852.84 / $14,852.84 / $14,852.84
| Facility | | $14,852.84 | $14,852.84 | $14,852.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,166.87 / $6,586.64 / $7,959.95
| Professional | | $5,166.87 | $6,586.64 | $7,959.95 |
- 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
- $4,223.31 / $5,775.29 / $8,768.33
| Professional | | $4,223.31 | $5,775.29 | $8,768.33 |