- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,210.77 / $8,477.27 / $20,928.72
| Facility | | $2,210.77 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,210.77 / $2,210.77 / $12,969.30
| Professional | | $2,210.77 | $2,210.77 | $12,969.30 |
- 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
- $2,119.67 / $3,613.07 / $4,817.42
| Professional | | $2,119.67 | $3,613.07 | $4,817.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,454.00 / $5,416.30 / $7,364.87
| Professional | | $3,454.00 | $5,416.30 | $7,364.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,210.77 / $3,868.85 / $8,757.16
| Facility | | $2,210.77 | $3,868.85 | $8,757.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,001.51 / $4,502.26 / $6,805.46
| Professional | | $3,001.51 | $4,502.26 | $6,805.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,501.05 / $5,143.80 / $7,506.29
| Facility | | $2,501.05 | $5,143.80 | $7,506.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,431.00 / $4,759.46 / $7,364.87
| Professional | | $3,431.00 | $4,759.46 | $7,364.87 |
- 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
- $3,001.51 / $4,875.18 / $5,814.62
| Professional | | $3,001.51 | $4,875.18 | $5,814.62 |