- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,533.07 / $4,746.71 / $7,920.26
| Facility | | $4,533.07 | $4,746.71 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,049.00 / $3,105.15 / $8,310.12
| Professional | | $2,049.00 | $3,105.15 | $8,310.12 |
- 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
- $2,286.31 / $4,339.38 / $6,389.40
| Professional | | $2,286.31 | $4,339.38 | $6,389.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,594.89 / $4,720.42 / $5,761.60
| Professional | | $3,594.89 | $4,720.42 | $5,761.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,470.31 / $4,052.42 / $6,305.19
| Facility | | $2,470.31 | $4,052.42 | $6,305.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,465.60 / $4,085.17 / $6,772.17
| Professional | | $3,465.60 | $4,085.17 | $6,772.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,013.65 / $4,379.22 / $4,618.97
| Facility | | $3,013.65 | $4,379.22 | $4,618.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.73 / $4,631.85 / $6,305.19
| Facility | | $2,509.73 | $4,631.85 | $6,305.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,851.71 / $4,988.00 / $6,536.00
| Professional | | $3,851.71 | $4,988.00 | $6,536.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,784.65 / $11,784.65 / $11,784.65
| Facility | | $11,784.65 | $11,784.65 | $11,784.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,224.02 / $5,380.77 / $6,507.43
| Professional | | $4,224.02 | $5,380.77 | $6,507.43 |
- 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
- $3,052.14 / $4,719.41 / $7,238.87
| Professional | | $3,052.14 | $4,719.41 | $7,238.87 |