- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.38 / $8,477.27 / $20,928.72
| Facility | | $1,361.38 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.38 / $1,361.38 / $7,989.91
| Professional | | $1,361.38 | $1,361.38 | $7,989.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.83 / $15,476.59 / $29,936.73
| Facility | | $11,766.83 | $15,476.59 | $29,936.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.84 / $2,253.15 / $3,004.21
| Professional | | $1,321.84 | $2,253.15 | $3,004.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,281.37 / $3,334.43 / $4,470.22
| Professional | | $2,281.37 | $3,334.43 | $4,470.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.38 / $2,382.42 / $4,406.00
| Facility | | $1,361.38 | $2,382.42 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,811.62 / $2,996.13 / $4,120.22
| Professional | | $1,811.62 | $2,996.13 | $4,120.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.51 / $3,423.18 / $4,688.72
| Facility | | $1,769.51 | $3,423.18 | $4,688.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.29 / $3,233.69 / $4,470.22
| Professional | | $2,293.29 | $3,233.69 | $4,470.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,556.73 / $2,714.30 / $3,023.46
| Professional | | $1,556.73 | $2,714.30 | $3,023.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,126.00 / $4,317.00 / $7,856.00
| Facility | | $3,126.00 | $4,317.00 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,811.62 / $3,093.68 / $3,901.94
| Professional | | $1,811.62 | $3,093.68 | $3,901.94 |