- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.62 / $6,239.30 / $7,920.26
| Facility | | $5,116.62 | $6,239.30 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,578.44 / $3,925.36 / $10,405.90
| Professional | | $2,578.44 | $3,925.36 | $10,405.90 |
- 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
- $2,871.20 / $5,453.20 / $8,045.26
| Professional | | $2,871.20 | $5,453.20 | $8,045.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,516.43 / $5,930.50 / $7,248.04
| Professional | | $4,516.43 | $5,930.50 | $7,248.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,108.60 / $5,091.26 / $7,919.43
| Facility | | $3,108.60 | $5,091.26 | $7,919.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,352.64 / $5,114.24 / $8,511.84
| Professional | | $4,352.64 | $5,114.24 | $8,511.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,962.04 / $5,501.85 / $5,805.55
| Facility | | $3,962.04 | $5,501.85 | $5,805.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.55 / $5,810.96 / $7,919.43
| Facility | | $3,248.55 | $5,810.96 | $7,919.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,838.97 / $6,280.67 / $8,229.85
| Professional | | $4,838.97 | $6,280.67 | $8,229.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,961.08 / $14,961.08 / $14,961.08
| Facility | | $14,961.08 | $14,961.08 | $14,961.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,313.25 / $6,763.03 / $8,185.45
| Professional | | $5,313.25 | $6,763.03 | $8,185.45 |
- 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
- $4,274.99 / $6,134.18 / $9,105.52
| Professional | | $4,274.99 | $6,134.18 | $9,105.52 |