- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,420.43 / $5,116.62 / $7,920.26
| Facility | | $4,420.43 | $5,116.62 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,988.77 / $3,045.35 / $7,960.79
| Professional | | $1,988.77 | $3,045.35 | $7,960.79 |
- 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
- $2,221.69 / $4,238.64 / $6,209.23
| Professional | | $2,221.69 | $4,238.64 | $6,209.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,496.87 / $4,591.70 / $5,622.75
| Professional | | $3,496.87 | $4,591.70 | $5,622.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,432.60 / $4,150.89 / $6,117.29
| Facility | | $2,432.60 | $4,150.89 | $6,117.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,373.65 / $3,931.20 / $6,579.63
| Professional | | $3,373.65 | $3,931.20 | $6,579.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,138.11 / $4,259.81 / $4,487.66
| Facility | | $3,138.11 | $4,259.81 | $4,487.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,504.15 / $4,515.53 / $6,117.29
| Facility | | $2,504.15 | $4,515.53 | $6,117.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,730.56 / $4,847.35 / $6,351.70
| Professional | | $3,730.56 | $4,847.35 | $6,351.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,950.62 / $10,950.62 / $10,950.62
| Facility | | $10,950.62 | $10,950.62 | $10,950.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,104.71 / $5,227.79 / $6,323.62
| Professional | | $4,104.71 | $5,227.79 | $6,323.62 |
- 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
- $3,210.47 / $4,682.85 / $7,100.46
| Professional | | $3,210.47 | $4,682.85 | $7,100.46 |