- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,943.28 / $14,454.40
| Facility | | $7,079.46 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,890.45 / $7,413.10
| Professional | | $3,388.44 | $3,890.45 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,244.36 / $14,125.38
| Facility | | $5,495.41 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,623.41 / $7,585.78
| Professional | | $3,311.31 | $5,623.41 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $6,918.31 / $12,022.64
| Professional | | $676.08 | $6,918.31 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,128.61 / $7,762.47
| Facility | | $3,388.44 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,585.78 / $28,840.32
| Professional | | $4,265.80 | $7,585.78 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,709.64 / $12,022.64
| Professional | | $7,244.36 | $8,709.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,128.31 / $12,022.64
| Professional | | $6,456.54 | $8,128.31 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $3,890.45 / $9,772.37
| Professional | | $7.08 | $3,890.45 | $9,772.37 |
- 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
- $4,168.69 / $5,888.44 / $9,772.37
| Professional | | $4,168.69 | $5,888.44 | $9,772.37 |