- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,846.82 / $7,920.26 / $20,980.06
| Facility | | $4,846.82 | $7,920.26 | $20,980.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,185.26 / $3,321.81 / $8,759.91
| Professional | | $2,185.26 | $3,321.81 | $8,759.91 |
- 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
- $2,451.91 / $4,637.21 / $6,836.10
| Professional | | $2,451.91 | $4,637.21 | $6,836.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,855.93 / $5,063.18 / $6,183.23
| Professional | | $3,855.93 | $5,063.18 | $6,183.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,557.58 / $4,346.67 / $6,735.59
| Facility | | $2,557.58 | $4,346.67 | $6,735.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,704.64 / $4,366.20 / $7,255.47
| Professional | | $3,704.64 | $4,366.20 | $7,255.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,420.57 / $4,697.21 / $4,948.62
| Facility | | $3,420.57 | $4,697.21 | $4,948.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,667.37 / $4,932.22 / $6,735.59
| Facility | | $2,667.37 | $4,932.22 | $6,735.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,114.89 / $5,336.39 / $6,992.95
| Professional | | $4,114.89 | $5,336.39 | $6,992.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,705.66 / $12,705.66 / $12,705.66
| Facility | | $12,705.66 | $12,705.66 | $12,705.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,523.55 / $5,764.77 / $6,968.86
| Professional | | $4,523.55 | $5,764.77 | $6,968.86 |
- 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
- $3,604.00 / $5,104.37 / $7,824.96
| Professional | | $3,604.00 | $5,104.37 | $7,824.96 |