- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $12,882.50 / $20,417.38
| Facility | | $5,754.40 | $12,882.50 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,370.32 / $7,413.10
| Professional | | $3,630.78 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $3,981.07
| Professional | | $426.58 | $426.58 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $10,715.19 / $25,118.86
| Facility | | $4,365.16 | $10,715.19 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $32,359.37 / $32,359.37
| Professional | | $6,760.83 | $32,359.37 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,220.18 / $25,703.96
| Facility | | $6,760.83 | $11,220.18 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,912.51 / $13,182.57
| Professional | | $7,079.46 | $8,912.51 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $6,456.54 / $12,022.64
| Professional | | $5,754.40 | $6,456.54 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $12,589.25 / $50,118.72
| Facility | | $8,709.64 | $12,589.25 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,918.31
| Professional | | $6,760.83 | $6,760.83 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,760.83 / $8,128.31
| Facility | | $6,025.60 | $6,760.83 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $8,912.51
| Professional | | $2,818.38 | $4,073.80 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $6,918.31 / $7,762.47
| Facility | | $5,754.40 | $6,918.31 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,760.83 / $13,489.63
| Professional | | $4,570.88 | $6,760.83 | $13,489.63 |