- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,498.47 / $5,116.62 / $7,920.26
| Facility | | $4,498.47 | $5,116.62 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.99 / $3,109.73 / $8,044.21
| Professional | | $1,947.99 | $3,109.73 | $8,044.21 |
- 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
- $2,243.96 / $4,267.20 / $6,344.16
| Professional | | $2,243.96 | $4,267.20 | $6,344.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,606.61 / $4,735.80 / $5,815.50
| Professional | | $3,606.61 | $4,735.80 | $5,815.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,504.94 / $3,944.24 / $5,654.12
| Facility | | $2,504.94 | $3,944.24 | $5,654.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,080.07 / $3,917.17 / $6,750.54
| Professional | | $3,080.07 | $3,917.17 | $6,750.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,673.90 / $4,083.65 / $4,604.24
| Facility | | $2,673.90 | $4,083.65 | $4,604.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,504.94 / $4,285.32 / $5,864.26
| Facility | | $2,504.94 | $4,285.32 | $5,864.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,680.98 / $4,904.72 / $6,453.68
| Professional | | $3,680.98 | $4,904.72 | $6,453.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,817.55 / $10,817.55 / $10,817.55
| Facility | | $10,817.55 | $10,817.55 | $10,817.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,203.10 / $5,363.60 / $6,475.22
| Professional | | $4,203.10 | $5,363.60 | $6,475.22 |
- 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
- $3,181.43 / $4,440.76 / $7,203.03
| Professional | | $3,181.43 | $4,440.76 | $7,203.03 |