- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $8,763.54 / $10,598.90
| Facility | | $5,116.62 | $8,763.54 | $10,598.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,920.77 / $5,941.64 / $16,062.80
| Professional | | $3,920.77 | $5,941.64 | $16,062.80 |
- 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
- $4,474.93 / $8,628.07 / $12,280.09
| Professional | | $4,474.93 | $8,628.07 | $12,280.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,888.92 / $9,045.78 / $10,975.96
| Professional | | $6,888.92 | $9,045.78 | $10,975.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,982.03 / $7,765.50 / $13,000.98
| Facility | | $3,982.03 | $7,765.50 | $13,000.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,771.78 / $8,066.95 / $13,026.63
| Professional | | $6,771.78 | $8,066.95 | $13,026.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,039.64 / $8,391.95 / $9,150.19
| Facility | | $6,039.64 | $8,391.95 | $9,150.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,051.50 / $8,913.42 / $13,000.98
| Facility | | $4,051.50 | $8,913.42 | $13,000.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,397.22 / $9,639.57 / $12,616.98
| Professional | | $7,397.22 | $9,639.57 | $12,616.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,428.22 / $24,428.22 / $24,428.22
| Facility | | $24,428.22 | $24,428.22 | $24,428.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,131.92 / $10,350.20 / $12,579.20
| Professional | | $8,131.92 | $10,350.20 | $12,579.20 |
- 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
- $6,427.32 / $9,181.91 / $13,936.01
| Professional | | $6,427.32 | $9,181.91 | $13,936.01 |