- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,606.93 / $9,120.11
| Facility | | $2,041.74 | $6,606.93 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,344.23 / $2,754.23
| Professional | | $1,949.84 | $2,344.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,079.46 / $13,803.84
| Facility | | $3,235.94 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,951.21 / $10,964.78
| Professional | | $1,737.80 | $2,951.21 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,754.40 / $8,317.64
| Facility | | $4,677.35 | $5,754.40 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,290.87 / $4,677.35
| Facility | | $2,089.30 | $2,290.87 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $4,265.80
| Professional | | $3,548.13 | $3,548.13 | $4,265.80 |
- 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
- $4,168.69 / $4,168.69 / $5,011.87
| Professional | | $4,168.69 | $4,168.69 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $4,677.35
| Professional | | $2,951.21 | $2,951.21 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,079.46 / $13,803.84
| Facility | | $3,235.94 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,951.21 / $10,964.78
| Professional | | $1,737.80 | $2,951.21 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,951.21 / $3,467.37
| Facility | | $1,737.80 | $2,951.21 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,238.72 / $5,128.61
| Professional | | $1,737.80 | $2,238.72 | $5,128.61 |