- 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
- $2,472.19 / $2,472.19 / $14,325.00
| Professional | | $2,472.19 | $2,472.19 | $14,325.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,362.84 / $10,999.42 / $21,276.43
| Facility | | $8,362.84 | $10,999.42 | $21,276.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,383.80 / $4,063.29 / $5,417.72
| Professional | | $2,383.80 | $4,063.29 | $5,417.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,029.00 / $6,047.37 / $8,157.22
| Professional | | $4,029.00 | $6,047.37 | $8,157.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,472.19 / $4,326.33 / $8,220.00
| Facility | | $2,472.19 | $4,326.33 | $8,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,326.92 / $4,990.38 / $7,506.02
| Professional | | $3,326.92 | $4,990.38 | $7,506.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,736.46 / $5,796.09 / $8,471.98
| Facility | | $2,736.46 | $5,796.09 | $8,471.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,349.00 / $5,260.07 / $8,157.22
| Professional | | $4,349.00 | $5,260.07 | $8,157.22 |
- 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
- $3,326.92 / $5,502.22 / $6,385.67
| Professional | | $3,326.92 | $5,502.22 | $6,385.67 |