- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $16,218.10
| Facility | | $4,466.84 | $5,495.41 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,388.44 / $5,888.44
| Professional | | $2,344.23 | $3,388.44 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $10,471.29
| Facility | | $5,888.44 | $5,888.44 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,890.45 / $6,456.54
| Professional | | $1,698.24 | $3,890.45 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,762.47 / $9,549.93
| Professional | | $3,630.78 | $7,762.47 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $5,011.87
| Facility | | $3,630.78 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $5,011.87
| Professional | | $3,388.44 | $4,365.16 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,801.89 / $5,370.32
| Facility | | $3,630.78 | $3,801.89 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,011.87 / $10,471.29
| Facility | | $2,691.53 | $5,011.87 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,981.07 / $5,370.32
| Professional | | $2,691.53 | $3,981.07 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,715.19 / $14,791.08
| Facility | | $5,370.32 | $10,715.19 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,090.30 / $4,365.16
| Professional | | $2,884.03 | $3,090.30 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $5,754.40
| Facility | | $4,365.16 | $4,365.16 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $4,365.16
| Professional | | $1,513.56 | $1,513.56 | $4,365.16 |