- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,943.28 / $14,454.40
| Facility | | $4,786.30 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,884.03 / $14,791.08
| Professional | | $2,511.89 | $2,884.03 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $11,748.98 / $22,908.68
| Facility | | $9,120.11 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,073.80 / $5,495.41
| Professional | | $2,398.83 | $4,073.80 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $7,943.28
| Professional | | $2,691.53 | $6,025.60 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,365.16 / $13,803.84
| Facility | | $2,630.27 | $4,365.16 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,370.32 / $19,952.62
| Professional | | $3,311.31 | $5,370.32 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,025.60 / $8,912.51
| Professional | | $5,888.44 | $6,025.60 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $5,888.44
| Professional | | $5,888.44 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $3,801.89 / $7,413.10
| Professional | | $10.96 | $3,801.89 | $7,413.10 |
- 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
- $3,548.13 / $5,248.07 / $7,079.46
| Professional | | $3,548.13 | $5,248.07 | $7,079.46 |