- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,943.28 / $14,454.40
| Facility | | $4,168.69 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,290.87 / $4,365.16
| Professional | | $1,949.84 | $2,290.87 | $4,365.16 |
- 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
- $1,905.46 / $3,235.94 / $4,265.80
| Professional | | $1,905.46 | $3,235.94 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $3,890.45 / $6,918.31
| Professional | | $676.08 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,162.28 / $5,128.61
| Facility | | $1,949.84 | $3,162.28 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,365.16 / $15,848.93
| Professional | | $2,630.27 | $4,365.16 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,011.87 / $6,918.31
| Professional | | $4,073.80 | $5,011.87 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,677.35 / $6,918.31
| Professional | | $3,715.35 | $4,677.35 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $3,235.94 / $5,495.41
| Professional | | $15.14 | $3,235.94 | $5,495.41 |
- 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
- $2,454.71 / $3,388.44 / $5,754.40
| Professional | | $2,454.71 | $3,388.44 | $5,754.40 |