- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,536.39 / $5,116.62 / $7,920.26
| Facility | | $4,536.39 | $5,116.62 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.60 / $3,104.66 / $8,204.33
| Professional | | $2,041.60 | $3,104.66 | $8,204.33 |
- 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
- $2,290.69 / $4,342.92 / $6,396.83
| Professional | | $2,290.69 | $4,342.92 | $6,396.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,601.42 / $4,728.99 / $5,769.54
| Professional | | $3,601.42 | $4,728.99 | $5,769.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,476.62 / $4,059.76 / $6,277.42
| Facility | | $2,476.62 | $4,059.76 | $6,277.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,436.20 / $4,068.70 / $6,785.91
| Professional | | $3,436.20 | $4,068.70 | $6,785.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,860.36 / $4,387.18 / $4,628.35
| Facility | | $2,860.36 | $4,387.18 | $4,628.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,513.53 / $4,608.49 / $6,277.42
| Facility | | $2,513.53 | $4,608.49 | $6,277.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,856.63 / $4,993.80 / $6,543.60
| Professional | | $3,856.63 | $4,993.80 | $6,543.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,939.04 / $11,939.04 / $11,939.04
| Facility | | $11,939.04 | $11,939.04 | $11,939.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,230.79 / $5,391.69 / $6,517.85
| Professional | | $4,230.79 | $5,391.69 | $6,517.85 |
- 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
- $3,308.96 / $4,829.76 / $7,179.79
| Professional | | $3,308.96 | $4,829.76 | $7,179.79 |