- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,943.28 / $14,454.40
| Facility | | $6,456.54 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,548.13 / $6,918.31
| Professional | | $3,162.28 | $3,548.13 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $12,302.69 / $23,988.33
| Facility | | $9,332.54 | $12,302.69 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,128.61 / $6,918.31
| Professional | | $3,019.95 | $5,128.61 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $9,772.37 / $15,848.93
| Professional | | $7,762.47 | $9,772.37 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,897.79 / $7,762.47
| Facility | | $3,162.28 | $4,897.79 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,079.46 / $25,703.96
| Professional | | $4,073.80 | $7,079.46 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,943.28 / $10,964.78
| Professional | | $6,606.93 | $7,943.28 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $7,413.10 / $10,964.78
| Professional | | $5,888.44 | $7,413.10 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $4,168.69 / $8,912.51
| Professional | | $12.88 | $4,168.69 | $8,912.51 |
- 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
- $3,890.45 / $5,370.32 / $9,120.11
| Professional | | $3,890.45 | $5,370.32 | $9,120.11 |