- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $6,213.66 / $7,920.26
| Facility | | $5,116.62 | $6,213.66 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.41 / $4,274.57 / $8,877.79
| Professional | | $2,570.41 | $4,274.57 | $8,877.79 |
- 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
- $2,858.68 / $5,430.41 / $8,009.97
| Professional | | $2,858.68 | $5,430.41 | $8,009.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,496.78 / $5,904.69 / $7,216.67
| Professional | | $4,496.78 | $5,904.69 | $7,216.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,108.60 / $5,069.10 / $7,885.19
| Facility | | $3,108.60 | $5,069.10 | $7,885.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,328.32 / $5,130.34 / $8,474.52
| Professional | | $4,328.32 | $5,130.34 | $8,474.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,954.21 / $5,477.90 / $5,780.09
| Facility | | $3,954.21 | $5,477.90 | $5,780.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,234.20 / $5,791.82 / $7,885.19
| Facility | | $3,234.20 | $5,791.82 | $7,885.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,818.74 / $6,253.13 / $8,193.75
| Professional | | $4,818.74 | $6,253.13 | $8,193.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,785.39 / $14,785.39 / $14,785.39
| Facility | | $14,785.39 | $14,785.39 | $14,785.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,291.72 / $6,733.37 / $8,152.29
| Professional | | $5,291.72 | $6,733.37 | $8,152.29 |
- 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
- $4,138.05 / $5,911.52 / $9,068.60
| Professional | | $4,138.05 | $5,911.52 | $9,068.60 |