- 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
- $4,265.80 / $5,011.87 / $9,772.37
| Professional | | $4,265.80 | $5,011.87 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $11,481.54 / $22,387.21
| Facility | | $8,709.64 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,079.46 / $9,332.54
| Professional | | $4,168.69 | $7,079.46 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $8,709.64 / $15,135.61
| Professional | | $676.08 | $8,709.64 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,456.54 / $10,471.29
| Facility | | $3,630.78 | $6,456.54 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,549.93 / $35,481.34
| Professional | | $5,495.41 | $9,549.93 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,964.78 / $15,135.61
| Professional | | $8,912.51 | $10,964.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,232.93 / $15,135.61
| Professional | | $8,128.31 | $10,232.93 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $2,187.76 / $12,302.69
| Professional | | $7.08 | $2,187.76 | $12,302.69 |
- 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
- $5,248.07 / $7,413.10 / $12,589.25
| Professional | | $5,248.07 | $7,413.10 | $12,589.25 |