- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,943.28 / $9,120.11
| Facility | | $5,495.41 | $7,943.28 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,265.80 / $9,772.37
| Professional | | $3,467.37 | $4,265.80 | $9,772.37 |
- 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 / $6,456.54 / $9,549.93
| Professional | | $1,412.54 | $6,456.54 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,244.36 / $8,709.64
| Professional | | $5,248.07 | $7,244.36 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,011.87 / $8,912.51
| Facility | | $3,311.31 | $5,011.87 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,918.31 / $9,120.11
| Professional | | $5,495.41 | $6,918.31 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,079.46 / $7,585.78
| Facility | | $5,495.41 | $7,079.46 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,011.87 / $8,511.38
| Facility | | $3,019.95 | $5,011.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $7,244.36 / $10,000.00
| Professional | | $79.43 | $7,244.36 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $19,952.62
| Facility | | $19,952.62 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,943.28 / $10,000.00
| Professional | | $7,079.46 | $7,943.28 | $10,000.00 |
- 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
- $3,981.07 / $7,413.10 / $10,715.19
| Professional | | $3,981.07 | $7,413.10 | $10,715.19 |