- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,715.19 / $14,791.08
| Facility | | $3,311.31 | $10,715.19 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,801.89 / $4,570.88
| Professional | | $3,162.28 | $3,801.89 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $12,302.69 / $22,908.68
| Facility | | $5,011.87 | $12,302.69 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,786.30 / $14,125.38
| Professional | | $2,884.03 | $4,786.30 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,025.60 / $8,511.38
| Facility | | $4,786.30 | $6,025.60 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,715.35 / $7,762.47
| Facility | | $3,235.94 | $3,715.35 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $6,918.31
| Professional | | $5,888.44 | $5,888.44 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $8,128.31
| Professional | | $6,918.31 | $6,918.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $10,232.93
| Professional | | $4,786.30 | $4,786.30 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $12,302.69 / $22,908.68
| Facility | | $5,011.87 | $12,302.69 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,786.30 / $14,125.38
| Professional | | $2,884.03 | $4,786.30 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,786.30 / $5,754.40
| Facility | | $2,884.03 | $4,786.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,786.30 / $9,772.37
| Professional | | $2,884.03 | $4,786.30 | $9,772.37 |