- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.83 / $8,477.27 / $20,928.72
| Facility | | $1,850.83 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,850.83 / $1,850.83 / $10,736.80
| Professional | | $1,850.83 | $1,850.83 | $10,736.80 |
- 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
- $1,784.88 / $3,042.40 / $4,056.54
| Professional | | $1,784.88 | $3,042.40 | $4,056.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,719.52 / $4,528.91 / $6,117.89
| Professional | | $3,719.52 | $4,528.91 | $6,117.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.83 / $3,424.04 / $8,220.00
| Facility | | $1,850.83 | $3,424.04 | $8,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,493.60 / $4,229.52 / $5,697.87
| Professional | | $2,493.60 | $4,229.52 | $5,697.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,302.26 / $4,622.31 / $6,342.51
| Facility | | $2,302.26 | $4,622.31 | $6,342.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,463.94 / $4,519.62 / $6,117.89
| Professional | | $3,463.94 | $4,519.62 | $6,117.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,493.60 / $4,124.02 / $5,370.82
| Professional | | $2,493.60 | $4,124.02 | $5,370.82 |