- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,882.50 / $21,877.62
| Facility | | $4,365.16 | $12,882.50 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,570.40 / $3,311.31
| Professional | | $1,905.46 | $2,570.40 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $15,848.93 / $16,218.10
| Facility | | $7,943.28 | $15,848.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,019.95 / $4,897.79
| Professional | | $1,258.93 | $3,019.95 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,398.83 / $5,248.07
| Professional | | $1,862.09 | $2,398.83 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,466.84 / $10,471.29
| Facility | | $2,137.96 | $4,466.84 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,801.89 / $4,265.80
| Professional | | $3,162.28 | $3,801.89 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,467.37 / $5,495.41
| Professional | | $2,818.38 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $15,135.61 / $15,135.61
| Facility | | $15,135.61 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,848.93 / $23,442.29 / $23,442.29
| Professional | | $15,848.93 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,801.89 / $8,317.64
| Facility | | $2,398.83 | $3,801.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,467.37 / $3,467.37
| Professional | | $3,162.28 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,162.28 / $3,162.28
| Facility | | $1,318.26 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $6,025.60
| Professional | | $1,318.26 | $1,318.26 | $6,025.60 |