- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,943.28 / $14,454.40
| Facility | | $2,511.89 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,412.54 / $7,413.10
| Professional | | $1,258.93 | $1,412.54 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $18,620.87 / $36,307.81
| Facility | | $14,454.40 | $18,620.87 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,041.74 / $2,754.23
| Professional | | $1,202.26 | $2,041.74 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,090.30 / $3,890.45
| Professional | | $1,513.56 | $3,090.30 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,187.76 / $9,772.37
| Facility | | $1,258.93 | $2,187.76 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,511.89 / $10,232.93
| Professional | | $1,445.44 | $2,511.89 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,162.28 / $4,265.80
| Professional | | $2,630.27 | $3,162.28 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,162.28 / $4,265.80
| Professional | | $3,019.95 | $3,162.28 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,511.38 / $19,498.45
| Facility | | $7,079.46 | $8,511.38 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,454.71 / $3,467.37
| Professional | | $1,445.44 | $2,454.71 | $3,467.37 |