- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,943.28 / $14,454.40
| Facility | | $7,244.36 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,168.69 / $8,128.31
| Professional | | $3,630.78 | $4,168.69 | $8,128.31 |
- 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
- $3,548.13 / $6,025.60 / $8,128.31
| Professional | | $3,548.13 | $6,025.60 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $7,413.10 / $13,182.57
| Professional | | $676.08 | $7,413.10 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,623.41 / $8,511.38
| Facility | | $3,630.78 | $5,623.41 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $8,128.31 / $31,622.78
| Professional | | $4,677.35 | $8,128.31 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $9,332.54 / $13,182.57
| Professional | | $7,762.47 | $9,332.54 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,912.51 / $13,182.57
| Professional | | $6,918.31 | $8,912.51 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $4,168.69 / $10,471.29
| Professional | | $7.08 | $4,168.69 | $10,471.29 |
- 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
- $4,466.84 / $6,309.57 / $10,715.19
| Professional | | $4,466.84 | $6,309.57 | $10,715.19 |