- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,373.23 / $2,373.23 / $13,761.90
| Professional | | $2,373.23 | $2,373.23 | $13,761.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,952.65 / $9,144.62 / $17,688.66
| Facility | | $6,952.65 | $9,144.62 | $17,688.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,287.55 / $3,899.25 / $5,199.00
| Professional | | $2,287.55 | $3,899.25 | $5,199.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,130.00 / $5,800.40 / $7,822.40
| Professional | | $4,130.00 | $5,800.40 | $7,822.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,373.23 / $4,153.14 / $8,220.00
| Facility | | $2,373.23 | $4,153.14 | $8,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,197.22 / $5,287.71 / $7,211.29
| Professional | | $3,197.22 | $5,287.71 | $7,211.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,078.75 / $5,924.07 / $8,137.22
| Facility | | $3,078.75 | $5,924.07 | $8,137.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,429.03 / $5,477.61 / $7,822.40
| Professional | | $4,429.03 | $5,477.61 | $7,822.40 |
- 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
- $3,197.22 / $5,287.71 / $6,886.32
| Professional | | $3,197.22 | $5,287.71 | $6,886.32 |