- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,045.97 / $8,477.27 / $20,928.72
| Facility | | $2,045.97 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,045.97 / $2,045.97 / $12,003.10
| Professional | | $2,045.97 | $2,045.97 | $12,003.10 |
- 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
- $1,961.89 / $3,344.11 / $4,458.82
| Professional | | $1,961.89 | $3,344.11 | $4,458.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,183.68 / $5,016.62 / $6,816.53
| Professional | | $3,183.68 | $5,016.62 | $6,816.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,045.97 / $3,580.45 / $8,757.16
| Facility | | $2,045.97 | $3,580.45 | $8,757.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,775.40 / $4,163.09 / $6,297.42
| Professional | | $2,775.40 | $4,163.09 | $6,297.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,309.66 / $4,448.21 / $6,816.53
| Facility | | $2,309.66 | $4,448.21 | $6,816.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,993.32 / $4,360.77 / $6,816.53
| Professional | | $2,993.32 | $4,360.77 | $6,816.53 |
- 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
- $2,675.72 / $4,303.66 / $5,284.74
| Professional | | $2,675.72 | $4,303.66 | $5,284.74 |