- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,598.21 / $8,477.27 / $20,928.72
| Facility | | $1,598.21 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,598.21 / $1,598.21 / $9,238.40
| Professional | | $1,598.21 | $1,598.21 | $9,238.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,306.43 / $5,664.13 / $10,956.25
| Facility | | $4,306.43 | $5,664.13 | $10,956.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,542.57 / $2,629.38 / $3,505.86
| Professional | | $1,542.57 | $2,629.38 | $3,505.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,214.57 / $3,916.36 / $5,250.37
| Professional | | $3,214.57 | $3,916.36 | $5,250.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,598.21 / $2,876.78 / $6,451.00
| Facility | | $1,598.21 | $2,876.78 | $6,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,142.21 / $3,633.51 / $4,861.33
| Professional | | $2,142.21 | $3,633.51 | $4,861.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.40 / $3,214.57 / $5,250.37
| Facility | | $1,351.40 | $3,214.57 | $5,250.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,972.75 / $3,943.06 / $5,250.37
| Professional | | $2,972.75 | $3,943.06 | $5,250.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,142.21 / $3,730.94 / $4,347.03
| Professional | | $2,142.21 | $3,730.94 | $4,347.03 |