- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,565.62 / $7,287.04 / $8,025.46
| Facility | | $2,565.62 | $7,287.04 | $8,025.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.90 / $1,554.57 / $1,651.73
| Professional | | $1,029.90 | $1,554.57 | $1,651.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,515.70 / $1,515.70 / $1,515.70
| Professional | | $1,515.70 | $1,515.70 | $1,515.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.98 / $2,524.66 / $5,806.42
| Facility | | $1,300.98 | $2,524.66 | $5,806.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,366.27 / $9,366.27 / $9,366.27
| Professional | | $9,366.27 | $9,366.27 | $9,366.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,040.37 / $2,623.33 / $4,799.72
| Professional | | $2,040.37 | $2,623.33 | $4,799.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,990.60 / $8,025.46 / $8,025.46
| Facility | | $2,990.60 | $8,025.46 | $8,025.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.33 / $1,651.73 / $8,025.46
| Professional | | $1,275.33 | $1,651.73 | $8,025.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,875.95 / $2,914.82 / $3,886.42
| Professional | | $2,875.95 | $2,914.82 | $3,886.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,354.03 / $2,455.23 / $6,448.99
| Facility | | $1,354.03 | $2,455.23 | $6,448.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,366.27 / $9,366.27 / $9,366.27
| Professional | | $9,366.27 | $9,366.27 | $9,366.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.21 / $1,943.21 / $2,137.53
| Facility | | $1,943.21 | $1,943.21 | $2,137.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.21 / $1,943.21 / $2,137.53
| Professional | | $1,943.21 | $1,943.21 | $2,137.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.15 / $1,165.93 / $2,914.82
| Professional | | $816.15 | $1,165.93 | $2,914.82 |