- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $8,477.27 / $19,276.96
| Facility | | $4,382.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,150.06 / $2,150.06 / $2,987.61
| Professional | | $2,150.06 | $2,150.06 | $2,987.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,099.31 / $6,706.99 / $12,973.48
| Facility | | $5,099.31 | $6,706.99 | $12,973.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,038.93 / $3,475.44 / $4,633.93
| Professional | | $2,038.93 | $3,475.44 | $4,633.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,176.92 / $5,241.78 / $7,094.41
| Professional | | $2,176.92 | $5,241.78 | $7,094.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,150.06 / $3,762.61 / $8,816.00
| Facility | | $2,150.06 | $3,762.61 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,792.94 / $4,843.82 / $20,218.62
| Professional | | $2,792.94 | $4,843.82 | $20,218.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,721.35 / $4,319.41 / $5,450.43
| Facility | | $2,721.35 | $4,319.41 | $5,450.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,158.57 / $4,599.78 / $6,387.71
| Professional | | $3,158.57 | $4,599.78 | $6,387.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,792.94 / $5,115.07 / $5,439.65
| Professional | | $2,792.94 | $5,115.07 | $5,439.65 |