- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $5,224.13 / $7,920.26
| Facility | | $2,747.00 | $5,224.13 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,010.18 / $3,156.85 / $7,535.74
| Professional | | $2,010.18 | $3,156.85 | $7,535.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,945.96 / $4,521.08 / $7,350.76
| Professional | | $2,945.96 | $4,521.08 | $7,350.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,395.64 / $5,175.64 / $6,177.00
| Professional | | $4,395.64 | $5,175.64 | $6,177.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,904.42 / $4,261.75 / $5,593.00
| Facility | | $2,904.42 | $4,261.75 | $5,593.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,504.94 / $4,250.58 / $6,558.03
| Professional | | $3,504.94 | $4,250.58 | $6,558.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.61 / $4,158.68 / $5,008.25
| Facility | | $3,036.61 | $4,158.68 | $5,008.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,904.42 / $4,310.24 / $6,362.81
| Facility | | $2,904.42 | $4,310.24 | $6,362.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,060.98 / $4,962.64 / $6,821.80
| Professional | | $4,060.98 | $4,962.64 | $6,821.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,962.14 / $11,962.14 / $11,962.14
| Facility | | $11,962.14 | $11,962.14 | $11,962.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,559.83 / $5,834.24 / $7,841.28
| Professional | | $4,559.83 | $5,834.24 | $7,841.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $7,664.00 / $36,803.00
| Facility | | $2,364.00 | $7,664.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.13 / $4,689.30 / $7,662.05
| Professional | | $3,311.13 | $4,689.30 | $7,662.05 |