- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,943.28 / $14,454.40
| Facility | | $4,677.35 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,630.27 / $13,489.63
| Professional | | $2,238.72 | $2,630.27 | $13,489.63 |
- 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
- $2,137.96 / $3,630.78 / $4,897.79
| Professional | | $2,137.96 | $3,630.78 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,495.41 / $6,918.31
| Professional | | $2,754.23 | $5,495.41 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,890.45 / $13,803.84
| Facility | | $2,238.72 | $3,890.45 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,570.88 / $18,620.87
| Professional | | $2,754.23 | $4,570.88 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,623.41 / $8,128.31
| Professional | | $4,677.35 | $5,623.41 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,623.41 / $8,128.31
| Professional | | $5,370.32 | $5,623.41 | $8,128.31 |
- 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
- $2,754.23 / $4,365.16 / $6,025.60
| Professional | | $2,754.23 | $4,365.16 | $6,025.60 |