- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $6,242.29 / $7,920.26
| Facility | | $5,116.62 | $6,242.29 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,550.92 / $3,746.21 / $10,198.70
| Professional | | $2,550.92 | $3,746.21 | $10,198.70 |
- 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
- $2,849.37 / $5,350.84 / $7,511.81
| Professional | | $2,849.37 | $5,350.84 | $7,511.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,545.84 / $5,969.10 / $7,302.38
| Professional | | $4,545.84 | $5,969.10 | $7,302.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.11 / $5,104.76 / $7,988.85
| Facility | | $3,044.11 | $5,104.76 | $7,988.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,442.88 / $4,949.09 / $8,538.39
| Professional | | $4,442.88 | $4,949.09 | $8,538.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,807.69 / $5,265.53 / $5,823.64
| Facility | | $3,807.69 | $5,265.53 | $5,823.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,125.33 / $5,702.08 / $7,988.85
| Facility | | $3,125.33 | $5,702.08 | $7,988.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,577.08 / $6,217.92 / $7,949.72
| Professional | | $4,577.08 | $6,217.92 | $7,949.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,947.84 / $13,947.84 / $13,947.84
| Facility | | $13,947.84 | $13,947.84 | $13,947.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,274.78 / $6,718.99 / $8,187.35
| Professional | | $5,274.78 | $6,718.99 | $8,187.35 |
- 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
- $3,848.16 / $5,719.78 / $9,193.14
| Professional | | $3,848.16 | $5,719.78 | $9,193.14 |