- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $8,709.64 / $12,022.64
| Facility | | $2,691.53 | $8,709.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $9,549.93
| Professional | | $2,570.40 | $3,162.28 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $13,489.63
| Facility | | $2,884.03 | $4,466.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,890.45 / $14,454.40
| Professional | | $2,344.23 | $3,890.45 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,762.47 / $10,964.78
| Facility | | $6,165.95 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Professional | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,019.95 / $7,585.78
| Facility | | $2,511.89 | $3,019.95 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,677.35 / $9,772.37
| Professional | | $2,041.74 | $4,677.35 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $5,888.44 / $22,387.21
| Facility | | $83.18 | $5,888.44 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $6,606.93
| Professional | | $5,623.41 | $5,623.41 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $8,128.31
| Professional | | $3,890.45 | $3,890.45 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $13,489.63
| Facility | | $2,884.03 | $4,466.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,890.45 / $14,454.40
| Professional | | $2,344.23 | $3,890.45 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,890.45 / $4,677.35
| Facility | | $2,344.23 | $3,890.45 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,388.44 / $7,413.10
| Professional | | $2,344.23 | $3,388.44 | $7,413.10 |