- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $7,920.26 / $8,982.32
| Facility | | $5,116.62 | $7,920.26 | $8,982.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,324.80 / $5,034.97 / $13,798.90
| Professional | | $3,324.80 | $5,034.97 | $13,798.90 |
- 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
- $3,777.12 / $7,179.20 / $10,384.62
| Professional | | $3,777.12 | $7,179.20 | $10,384.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,839.24 / $7,667.45 / $9,316.50
| Professional | | $5,839.24 | $7,667.45 | $9,316.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,377.37 / $6,582.42 / $10,583.31
| Facility | | $3,377.37 | $6,582.42 | $10,583.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,797.68 / $6,739.89 / $11,030.55
| Professional | | $5,797.68 | $6,739.89 | $11,030.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,684.26 / $7,113.26 / $7,523.43
| Facility | | $4,684.26 | $7,113.26 | $7,523.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,434.16 / $7,583.25 / $10,583.31
| Facility | | $3,434.16 | $7,583.25 | $10,583.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,271.42 / $8,122.60 / $10,624.80
| Professional | | $6,271.42 | $8,122.60 | $10,624.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,794.91 / $19,794.91 / $19,794.91
| Facility | | $19,794.91 | $19,794.91 | $19,794.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,879.73 / $8,764.23 / $10,600.79
| Professional | | $6,879.73 | $8,764.23 | $10,600.79 |
- 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
- $5,637.54 / $8,268.39 / $12,377.28
| Professional | | $5,637.54 | $8,268.39 | $12,377.28 |