- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,495.41 / $7,244.36
| Facility | | $2,187.76 | $5,495.41 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,290.87 / $3,388.44
| Professional | | $1,949.84 | $2,290.87 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $15,135.61 / $18,197.01
| Facility | | $11,748.98 | $15,135.61 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,949.84
| Professional | | $1,174.90 | $1,174.90 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,398.83 / $2,630.27
| Professional | | $2,238.72 | $2,398.83 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,244.36 / $14,791.08
| Facility | | $2,951.21 | $7,244.36 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $4,265.80
| Professional | | $3,548.13 | $3,548.13 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,235.94 / $4,073.80
| Professional | | $2,951.21 | $3,235.94 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,818.38 / $4,570.88
| Facility | | $2,187.76 | $2,818.38 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $6,165.95
| Professional | | $1,905.46 | $1,905.46 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,388.44 / $6,025.60
| Facility | | $2,187.76 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,388.44 / $6,025.60
| Professional | | $2,187.76 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,951.21 / $3,467.37
| Facility | | $1,737.80 | $2,951.21 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,445.44 / $3,388.44
| Professional | | $1,230.27 | $1,445.44 | $3,388.44 |