- 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
- $2,551.27 / $2,551.27 / $14,823.10
| Professional | | $2,551.27 | $2,551.27 | $14,823.10 |
- 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
- $2,459.82 / $4,192.88 / $5,590.50
| Professional | | $2,459.82 | $4,192.88 | $5,590.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,316.31 / $6,235.92 / $8,455.82
| Professional | | $4,316.31 | $6,235.92 | $8,455.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,551.27 / $4,464.72 / $9,696.00
| Facility | | $2,551.27 | $4,464.72 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,444.17 / $5,166.25 / $7,767.09
| Professional | | $3,444.17 | $5,166.25 | $7,767.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,616.64 / $5,996.52 / $8,455.82
| Facility | | $4,616.64 | $5,996.52 | $8,455.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,192.28 / $5,452.63 / $8,455.82
| Professional | | $4,192.28 | $5,452.63 | $8,455.82 |
- 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
- $3,444.17 / $5,166.25 / $6,589.93
| Professional | | $3,444.17 | $5,166.25 | $6,589.93 |