- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.53 / $8,477.27 / $20,928.72
| Facility | | $1,459.53 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.53 / $1,459.53 / $8,574.76
| Professional | | $1,459.53 | $1,459.53 | $8,574.76 |
- 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
- $1,416.67 / $2,414.78 / $3,219.69
| Professional | | $1,416.67 | $2,414.78 | $3,219.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,388.00 / $3,479.09 / $4,664.18
| Professional | | $2,388.00 | $3,479.09 | $4,664.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.53 / $2,554.17 / $4,406.00
| Facility | | $1,459.53 | $2,554.17 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,944.70 / $2,984.12 / $4,421.12
| Professional | | $1,944.70 | $2,984.12 | $4,421.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.09 / $3,449.57 / $4,961.95
| Facility | | $1,683.09 | $3,449.57 | $4,961.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,224.00 / $3,320.35 / $4,664.18
| Professional | | $2,224.00 | $3,320.35 | $4,664.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,668.17 / $2,908.61 / $3,226.28
| Professional | | $1,668.17 | $2,908.61 | $3,226.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,944.70 / $3,320.94 / $3,946.24
| Professional | | $1,944.70 | $3,320.94 | $3,946.24 |