- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $6,126.08 / $7,920.26
| Facility | | $5,116.62 | $6,126.08 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,528.00 / $3,831.07 / $10,192.10
| Professional | | $2,528.00 | $3,831.07 | $10,192.10 |
- 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
- $2,827.31 / $5,358.88 / $7,893.88
| Professional | | $2,827.31 | $5,358.88 | $7,893.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,445.28 / $5,837.06 / $7,122.48
| Professional | | $4,445.28 | $5,837.06 | $7,122.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,945.60 / $5,011.04 / $7,784.30
| Facility | | $2,945.60 | $5,011.04 | $7,784.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,279.41 / $5,046.00 / $8,374.32
| Professional | | $4,279.41 | $5,046.00 | $8,374.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,887.14 / $5,375.41 / $5,711.75
| Facility | | $3,887.14 | $5,375.41 | $5,711.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,082.04 / $5,709.89 / $7,784.30
| Facility | | $3,082.04 | $5,709.89 | $7,784.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,755.27 / $6,162.50 / $8,075.00
| Professional | | $4,755.27 | $6,162.50 | $8,075.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,591.99 / $14,591.99 / $14,591.99
| Facility | | $14,591.99 | $14,591.99 | $14,591.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,222.22 / $6,653.76 / $8,045.22
| Professional | | $5,222.22 | $6,653.76 | $8,045.22 |
- 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
- $4,135.50 / $5,751.16 / $8,862.27
| Professional | | $4,135.50 | $5,751.16 | $8,862.27 |