- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $5,799.29 / $7,920.26
| Facility | | $5,116.62 | $5,799.29 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,369.73 / $3,627.14 / $7,710.81
| Professional | | $2,369.73 | $3,627.14 | $7,710.81 |
- 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
- $2,682.19 / $5,066.75 / $7,458.33
| Professional | | $2,682.19 | $5,066.75 | $7,458.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,219.07 / $5,540.02 / $6,770.61
| Professional | | $4,219.07 | $5,540.02 | $6,770.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,927.18 / $4,756.03 / $7,355.74
| Facility | | $2,927.18 | $4,756.03 | $7,355.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,931.20 / $4,659.30 / $7,932.27
| Professional | | $3,931.20 | $4,659.30 | $7,932.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,554.15 / $4,889.66 / $5,410.25
| Facility | | $3,554.15 | $4,889.66 | $5,410.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,035.01 / $5,306.75 / $7,355.74
| Facility | | $3,035.01 | $5,306.75 | $7,355.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,496.04 / $5,822.48 / $7,629.45
| Professional | | $4,496.04 | $5,822.48 | $7,629.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,198.96 / $13,198.96 / $13,198.96
| Facility | | $13,198.96 | $13,198.96 | $13,198.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,939.31 / $6,302.54 / $7,609.37
| Professional | | $4,939.31 | $6,302.54 | $7,609.37 |
- 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
- $3,802.05 / $5,442.14 / $8,464.67
| Professional | | $3,802.05 | $5,442.14 | $8,464.67 |