- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.58 / $8,477.27 / $20,928.72
| Facility | | $1,129.58 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.00 / $1,129.58 / $6,035.41
| Professional | | $1,102.00 | $1,129.58 | $6,035.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,086.90 / $11,951.75 / $23,118.55
| Facility | | $9,086.90 | $11,951.75 | $23,118.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.92 / $1,854.41 / $2,472.55
| Professional | | $1,087.92 | $1,854.41 | $2,472.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,879.65 / $2,767.43 / $3,710.09
| Professional | | $1,879.65 | $2,767.43 | $3,710.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.58 / $1,976.77 / $8,757.16
| Facility | | $1,129.58 | $1,976.77 | $8,757.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.92 / $2,510.40 / $3,437.84
| Professional | | $1,517.92 | $2,510.40 | $3,437.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.56 / $2,735.78 / $3,786.90
| Facility | | $1,443.56 | $2,735.78 | $3,786.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,946.00 / $2,497.92 / $3,710.09
| Professional | | $1,946.00 | $2,497.92 | $3,710.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.92 / $2,564.28 / $3,269.36
| Professional | | $1,517.92 | $2,564.28 | $3,269.36 |