- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,709.64 / $10,715.19
| Facility | | $6,606.93 | $8,709.64 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,128.61 / $11,481.54
| Professional | | $4,073.80 | $5,128.61 | $11,481.54 |
- 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 / $7,585.78 / $11,481.54
| Professional | | $1,412.54 | $7,585.78 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,317.64 / $10,232.93
| Professional | | $6,165.95 | $8,317.64 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,888.44 / $10,715.19
| Facility | | $3,981.07 | $5,888.44 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,128.31 / $10,964.78
| Professional | | $6,456.54 | $8,128.31 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,317.64 / $9,120.11
| Facility | | $6,760.83 | $8,317.64 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,888.44 / $10,000.00
| Facility | | $3,630.78 | $5,888.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $8,709.64 / $12,022.64
| Professional | | $79.43 | $8,709.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $24,547.09
| Facility | | $24,547.09 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $9,332.54 / $12,022.64
| Professional | | $8,317.64 | $9,332.54 | $12,022.64 |
- 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
- $4,786.30 / $8,709.64 / $12,589.25
| Professional | | $4,786.30 | $8,709.64 | $12,589.25 |