- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $7,920.26 / $9,341.77
| Facility | | $5,116.62 | $7,920.26 | $9,341.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,349.96 / $5,254.44 / $14,350.40
| Professional | | $3,349.96 | $5,254.44 | $14,350.40 |
- 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
- $3,872.39 / $7,289.02 / $10,789.54
| Professional | | $3,872.39 | $7,289.02 | $10,789.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,092.21 / $7,999.63 / $9,781.57
| Professional | | $6,092.21 | $7,999.63 | $9,781.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,046.75 / $6,867.58 / $9,576.76
| Facility | | $4,046.75 | $6,867.58 | $9,576.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,591.78 / $6,634.83 / $11,449.98
| Professional | | $5,591.78 | $6,634.83 | $11,449.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,860.25 / $6,943.21 / $7,809.52
| Facility | | $4,860.25 | $6,943.21 | $7,809.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,205.56 / $7,462.63 / $9,959.11
| Facility | | $4,205.56 | $7,462.63 | $9,959.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,328.98 / $8,364.95 / $11,026.57
| Professional | | $6,328.98 | $8,364.95 | $11,026.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,740.83 / $18,740.83 / $18,740.83
| Facility | | $18,740.83 | $18,740.83 | $18,740.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,138.65 / $9,097.51 / $10,997.63
| Professional | | $7,138.65 | $9,097.51 | $10,997.63 |
- 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
- $5,160.39 / $7,592.42 / $12,212.80
| Professional | | $5,160.39 | $7,592.42 | $12,212.80 |