- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,511.38 / $14,454.40
| Facility | | $7,244.36 | $8,511.38 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,071.52 / $1,096.48
| Professional | | $954.99 | $1,071.52 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $13,803.84 / $26,915.35
| Facility | | $10,715.19 | $13,803.84 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,548.82 / $2,089.30
| Professional | | $912.01 | $1,548.82 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,888.44 / $7,244.36
| Professional | | $2,041.74 | $5,888.44 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $9,332.54
| Facility | | $1,548.82 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $8,709.64 / $15,135.61
| Professional | | $2,137.96 | $8,709.64 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,818.38 / $10,964.78
| Professional | | $1,949.84 | $2,818.38 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Professional | | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,715.35 / $8,128.31
| Facility | | $630.96 | $3,715.35 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $8,128.31 / $14,454.40
| Professional | | $1,548.82 | $8,128.31 | $14,454.40 |