- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $10,471.29 / $13,489.63
| Facility | | $4,073.80 | $10,471.29 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,265.80 / $5,128.61
| Professional | | $3,630.78 | $4,265.80 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $28,840.32 / $33,884.42
| Facility | | $21,877.62 | $28,840.32 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $3,019.95
| Professional | | $1,698.24 | $1,698.24 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,466.84 / $4,897.79
| Professional | | $4,265.80 | $4,466.84 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $13,489.63 / $28,183.83
| Facility | | $5,623.41 | $13,489.63 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $7,943.28
| Professional | | $6,606.93 | $6,606.93 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,025.60 / $7,585.78
| Professional | | $5,495.41 | $6,025.60 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,248.07 / $8,511.38
| Facility | | $4,073.80 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Professional | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,309.57 / $11,481.54
| Facility | | $4,073.80 | $6,309.57 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,309.57 / $11,481.54
| Professional | | $4,073.80 | $6,309.57 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,495.41 / $6,606.93
| Facility | | $3,311.31 | $5,495.41 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,754.23 / $6,309.57
| Professional | | $2,290.87 | $2,754.23 | $6,309.57 |