- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $14,125.38 / $14,454.40
| Facility | | $3,090.30 | $14,125.38 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,454.71 / $4,073.80
| Professional | | $1,995.26 | $2,454.71 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $9,332.54
| Facility | | $5,248.07 | $5,248.07 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,918.31 / $8,511.38
| Professional | | $3,235.94 | $6,918.31 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,548.13 / $4,466.84
| Professional | | $3,090.30 | $3,548.13 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $4,466.84
| Facility | | $3,235.94 | $3,235.94 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,365.16 / $8,511.38
| Facility | | $2,238.72 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $3,548.13 / $4,466.84
| Professional | | $79.43 | $3,548.13 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $9,549.93 / $12,589.25
| Facility | | $4,786.30 | $9,549.93 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,691.53 / $3,801.89
| Professional | | $2,570.40 | $2,691.53 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $5,128.61
| Facility | | $3,801.89 | $3,801.89 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $3,801.89
| Professional | | $1,348.96 | $1,348.96 | $3,801.89 |