- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,188.44 / $9,011.27 / $10,767.80
| Facility | | $2,188.44 | $9,011.27 | $10,767.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,544.79 / $2,085.46 / $2,188.44
| Professional | | $1,544.79 | $2,085.46 | $2,188.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.23 / $2,008.23 / $2,008.23
| Professional | | $2,008.23 | $2,008.23 | $2,008.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,723.73 / $3,347.04 / $8,543.96
| Facility | | $1,723.73 | $3,347.04 | $8,543.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,409.81 / $12,409.81 / $12,409.81
| Professional | | $12,409.81 | $12,409.81 | $12,409.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,703.38 / $3,475.78 / $6,359.39
| Professional | | $2,703.38 | $3,475.78 | $6,359.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,866.87 / $8,884.10 / $10,767.80
| Facility | | $2,866.87 | $8,884.10 | $10,767.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,689.74 / $2,188.44 / $10,633.30
| Professional | | $1,689.74 | $2,188.44 | $10,633.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,810.48 / $3,861.97 / $5,149.30
| Professional | | $3,810.48 | $3,861.97 | $5,149.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,723.73 / $3,347.04 / $8,543.96
| Facility | | $1,723.73 | $3,347.04 | $8,543.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,409.81 / $12,409.81 / $12,409.81
| Professional | | $12,409.81 | $12,409.81 | $12,409.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.34 / $1,544.79 / $3,604.51
| Professional | | $1,081.34 | $1,544.79 | $3,604.51 |