- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,943.28 / $8,709.64
| Facility | | $5,248.07 | $7,943.28 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,981.07 / $9,332.54
| Professional | | $3,162.28 | $3,981.07 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $6,025.60 / $9,120.11
| Professional | | $660.69 | $6,025.60 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,760.83 / $8,128.31
| Professional | | $4,897.79 | $6,760.83 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,786.30 / $8,128.31
| Facility | | $3,467.37 | $4,786.30 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,165.95 / $8,511.38
| Professional | | $5,128.61 | $6,165.95 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,760.83 / $7,079.46
| Facility | | $4,897.79 | $6,760.83 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,786.30 / $7,943.28
| Facility | | $3,162.28 | $4,786.30 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $6,760.83 / $9,549.93
| Professional | | $79.43 | $6,760.83 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,413.10 / $9,549.93
| Professional | | $6,309.57 | $7,413.10 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,585.78 / $31,622.78
| Facility | | $1,412.54 | $7,585.78 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $6,760.83 / $10,000.00
| Professional | | $3,801.89 | $6,760.83 | $10,000.00 |