- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,385.71 / $5,116.62 / $7,920.26
| Facility | | $4,385.71 | $5,116.62 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,973.40 / $2,986.57 / $8,736.35
| Professional | | $1,973.40 | $2,986.57 | $8,736.35 |
- 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
- $2,244.59 / $4,328.01 / $6,145.15
| Professional | | $2,244.59 | $4,328.01 | $6,145.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,464.97 / $4,549.82 / $5,536.84
| Professional | | $3,464.97 | $4,549.82 | $5,536.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.35 / $4,130.34 / $6,591.20
| Facility | | $2,412.35 | $4,130.34 | $6,591.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,436.57 / $4,043.02 / $6,539.34
| Professional | | $3,436.57 | $4,043.02 | $6,539.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,167.76 / $4,220.96 / $4,591.51
| Facility | | $3,167.76 | $4,220.96 | $4,591.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,559.14 / $4,525.92 / $6,591.20
| Facility | | $2,559.14 | $4,525.92 | $6,591.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,722.18 / $4,826.33 / $6,308.01
| Professional | | $3,722.18 | $4,826.33 | $6,308.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,208.81 / $12,208.81 / $12,208.81
| Facility | | $12,208.81 | $12,208.81 | $12,208.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,072.73 / $5,195.79 / $6,274.35
| Professional | | $4,072.73 | $5,195.79 | $6,274.35 |
- 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
- $3,325.71 / $4,711.41 / $6,979.59
| Professional | | $3,325.71 | $4,711.41 | $6,979.59 |