- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,926.10 / $5,413.65 / $7,920.26
| Facility | | $4,926.10 | $5,413.65 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,201.88 / $3,233.30 / $7,181.53
| Professional | | $2,201.88 | $3,233.30 | $7,181.53 |
- 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
- $2,503.37 / $4,706.22 / $6,948.47
| Professional | | $2,503.37 | $4,706.22 | $6,948.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,942.42 / $5,176.76 / $6,351.00
| Professional | | $3,942.42 | $5,176.76 | $6,351.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,811.41 / $4,444.18 / $6,586.57
| Facility | | $2,811.41 | $4,444.18 | $6,586.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,648.54 / $4,457.18 / $7,390.05
| Professional | | $3,648.54 | $4,457.18 | $7,390.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,221.55 / $4,666.55 / $5,087.76
| Facility | | $3,221.55 | $4,666.55 | $5,087.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,811.41 / $4,975.39 / $6,586.57
| Facility | | $2,811.41 | $4,975.39 | $6,586.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,072.20 / $5,424.45 / $7,078.80
| Professional | | $4,072.20 | $5,424.45 | $7,078.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,490.91 / $12,490.91 / $12,490.91
| Facility | | $12,490.91 | $12,490.91 | $12,490.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,601.66 / $5,871.70 / $7,089.20
| Professional | | $4,601.66 | $5,871.70 | $7,089.20 |
- 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
- $3,462.35 / $5,032.31 / $7,809.16
| Professional | | $3,462.35 | $5,032.31 | $7,809.16 |