- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $6,682.64 / $7,920.26
| Facility | | $5,116.62 | $6,682.64 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,628.73 / $3,893.38 / $7,952.60
| Professional | | $2,628.73 | $3,893.38 | $7,952.60 |
- 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
- $3,051.46 / $5,712.24 / $8,084.37
| Professional | | $3,051.46 | $5,712.24 | $8,084.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,851.64 / $6,370.65 / $7,777.18
| Professional | | $4,851.64 | $6,370.65 | $7,777.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,257.55 / $5,469.12 / $7,944.42
| Facility | | $3,257.55 | $5,469.12 | $7,944.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,706.24 / $5,289.31 / $9,134.64
| Professional | | $4,706.24 | $5,289.31 | $9,134.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.92 / $5,630.68 / $6,230.33
| Facility | | $4,168.92 | $5,630.68 | $6,230.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,466.27 / $6,021.79 / $7,945.15
| Facility | | $3,466.27 | $6,021.79 | $7,945.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,916.52 / $6,650.51 / $8,518.28
| Professional | | $4,916.52 | $6,650.51 | $8,518.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,940.63 / $15,940.63 / $15,940.63
| Facility | | $15,940.63 | $15,940.63 | $15,940.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,635.19 / $7,197.43 / $8,773.85
| Professional | | $5,635.19 | $7,197.43 | $8,773.85 |
- 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
- $4,179.20 / $5,970.31 / $9,593.34
| Professional | | $4,179.20 | $5,970.31 | $9,593.34 |