- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,237.91 / $5,116.62 / $7,920.26
| Facility | | $4,237.91 | $5,116.62 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,916.47 / $2,909.40 / $7,615.83
| Professional | | $1,916.47 | $2,909.40 | $7,615.83 |
- 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
- $2,132.44 / $4,054.18 / $5,964.99
| Professional | | $2,132.44 | $4,054.18 | $5,964.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,354.21 / $4,404.38 / $5,382.28
| Professional | | $3,354.21 | $4,404.38 | $5,382.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.53 / $3,781.11 / $5,882.19
| Facility | | $2,226.53 | $3,781.11 | $5,882.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,151.20 / $3,803.96 / $6,318.33
| Professional | | $3,151.20 | $3,803.96 | $6,318.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.63 / $4,086.03 / $4,309.43
| Facility | | $2,840.63 | $4,086.03 | $4,309.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,325.71 / $4,321.60 / $5,882.19
| Facility | | $2,325.71 | $4,321.60 | $5,882.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,597.53 / $4,656.68 / $6,101.85
| Professional | | $3,597.53 | $4,656.68 | $6,101.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,078.40 / $11,078.40 / $11,078.40
| Facility | | $11,078.40 | $11,078.40 | $11,078.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,941.73 / $5,020.18 / $6,072.53
| Professional | | $3,941.73 | $5,020.18 | $6,072.53 |
- 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
- $3,174.99 / $4,403.71 / $6,755.09
| Professional | | $3,174.99 | $4,403.71 | $6,755.09 |