- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $6,385.78 / $7,920.26
| Facility | | $5,116.62 | $6,385.78 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,651.59 / $4,084.64 / $10,330.00
| Professional | | $2,651.59 | $4,084.64 | $10,330.00 |
- 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
- $3,000.53 / $5,665.50 / $8,396.29
| Professional | | $3,000.53 | $5,665.50 | $8,396.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,717.89 / $6,195.03 / $7,560.57
| Professional | | $4,717.89 | $6,195.03 | $7,560.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,732.02 / $5,166.32 / $8,297.08
| Facility | | $2,732.02 | $5,166.32 | $8,297.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,409.47 / $5,311.88 / $8,893.98
| Professional | | $4,409.47 | $5,311.88 | $8,893.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,942.58 / $5,747.25 / $6,066.18
| Facility | | $3,942.58 | $5,747.25 | $6,066.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,774.68 / $5,971.41 / $8,297.08
| Facility | | $2,774.68 | $5,971.41 | $8,297.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,036.16 / $6,541.97 / $8,588.95
| Professional | | $5,036.16 | $6,541.97 | $8,588.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,622.98 / $15,622.98 / $15,622.98
| Facility | | $15,622.98 | $15,622.98 | $15,622.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,406.73 / $7,030.43 / $8,514.00
| Professional | | $5,406.73 | $7,030.43 | $8,514.00 |
- 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
- $4,350.21 / $6,214.60 / $9,265.70
| Professional | | $4,350.21 | $6,214.60 | $9,265.70 |