- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $7,943.28 / $14,454.40
| Facility | | $6,760.83 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,801.89 / $7,244.36
| Professional | | $3,235.94 | $3,801.89 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $20,892.96 / $40,738.03
| Facility | | $15,848.93 | $20,892.96 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,370.32 / $7,079.46
| Professional | | $3,162.28 | $5,370.32 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $6,606.93 / $11,481.54
| Professional | | $1,445.44 | $6,606.93 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,248.07 / $7,943.28
| Facility | | $3,235.94 | $5,248.07 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,413.10 / $26,915.35
| Professional | | $4,677.35 | $7,413.10 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,511.38 / $11,481.54
| Professional | | $6,760.83 | $8,511.38 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,762.47 / $11,481.54
| Professional | | $6,309.57 | $7,762.47 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $15.14 / $9,120.11
| Professional | | $15.14 | $15.14 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,309.57 / $9,772.37
| Professional | | $4,073.80 | $6,309.57 | $9,772.37 |