- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $8,291.28 / $10,116.70
| Facility | | $5,116.62 | $8,291.28 | $10,116.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,633.10 / $5,689.68 / $14,900.70
| Professional | | $3,633.10 | $5,689.68 | $14,900.70 |
- 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
- $4,193.46 / $7,900.40 / $11,690.37
| Professional | | $4,193.46 | $7,900.40 | $11,690.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,596.35 / $8,661.60 / $10,585.61
| Professional | | $6,596.35 | $8,661.60 | $10,585.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,378.99 / $7,310.15 / $10,373.04
| Facility | | $4,378.99 | $7,310.15 | $10,373.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,829.12 / $7,186.18 / $12,403.83
| Professional | | $5,829.12 | $7,186.18 | $12,403.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,175.64 / $7,618.59 / $8,460.09
| Facility | | $5,175.64 | $7,618.59 | $8,460.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,426.67 / $7,923.82 / $10,790.61
| Facility | | $4,426.67 | $7,923.82 | $10,790.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,865.10 / $9,063.36 / $11,951.52
| Professional | | $6,865.10 | $9,063.36 | $11,951.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,353.87 / $20,353.87 / $20,353.87
| Facility | | $20,353.87 | $20,353.87 | $20,353.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,734.00 / $9,855.37 / $11,914.81
| Professional | | $7,734.00 | $9,855.37 | $11,914.81 |
- 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
- $5,679.48 / $8,290.64 / $13,254.07
| Professional | | $5,679.48 | $8,290.64 | $13,254.07 |