- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,550.83 / $5,116.62 / $7,920.26
| Facility | | $4,550.83 | $5,116.62 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,058.38 / $3,138.32 / $8,187.43
| Professional | | $2,058.38 | $3,138.32 | $8,187.43 |
- 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
- $2,294.77 / $4,355.78 / $6,381.97
| Professional | | $2,294.77 | $4,355.78 | $6,381.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,586.92 / $4,709.95 / $5,769.67
| Professional | | $3,586.92 | $4,709.95 | $5,769.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,444.89 / $4,043.43 / $6,333.88
| Facility | | $2,444.89 | $4,043.43 | $6,333.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,390.00 / $4,060.77 / $6,750.54
| Professional | | $3,390.00 | $4,060.77 | $6,750.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,933.17 / $4,369.51 / $4,604.24
| Facility | | $2,933.17 | $4,369.51 | $4,604.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,499.28 / $4,625.38 / $6,333.88
| Facility | | $2,499.28 | $4,625.38 | $6,333.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,841.28 / $4,982.20 / $6,528.40
| Professional | | $3,841.28 | $4,982.20 | $6,528.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,832.58 / $11,832.58 / $11,832.58
| Facility | | $11,832.58 | $11,832.58 | $11,832.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,214.80 / $5,363.60 / $6,493.22
| Professional | | $4,214.80 | $5,363.60 | $6,493.22 |
- 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
- $3,352.50 / $4,718.01 / $7,223.07
| Professional | | $3,352.50 | $4,718.01 | $7,223.07 |