- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,943.28 / $14,454.40
| Facility | | $3,162.28 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,737.80 / $8,912.51
| Professional | | $1,479.11 | $1,737.80 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $15,488.17 / $30,199.52
| Facility | | $11,748.98 | $15,488.17 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,454.71 / $3,235.94
| Professional | | $1,412.54 | $2,454.71 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,715.35 / $4,677.35
| Professional | | $1,819.70 | $3,715.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,630.27 / $13,803.84
| Facility | | $1,479.11 | $2,630.27 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,019.95 / $12,302.69
| Professional | | $1,778.28 | $3,019.95 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,715.35 / $5,370.32
| Professional | | $3,090.30 | $3,715.35 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,715.35 / $5,370.32
| Professional | | $3,548.13 | $3,715.35 | $5,370.32 |
- 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
- $1,819.70 / $2,884.03 / $3,981.07
| Professional | | $1,819.70 | $2,884.03 | $3,981.07 |