- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,561.46 / $8,477.27 / $20,928.72
| Facility | | $2,561.46 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,561.46 / $2,561.46 / $15,165.30
| Professional | | $2,561.46 | $2,561.46 | $15,165.30 |
- 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
- $2,481.42 / $4,229.71 / $5,639.60
| Professional | | $2,481.42 | $4,229.71 | $5,639.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,285.00 / $6,252.28 / $8,502.58
| Professional | | $4,285.00 | $6,252.28 | $8,502.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,561.46 / $4,442.08 / $7,313.11
| Facility | | $2,561.46 | $4,442.08 | $7,313.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,441.30 / $5,691.37 / $7,809.73
| Professional | | $3,441.30 | $5,691.37 | $7,809.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,345.29 / $6,516.47 / $9,377.16
| Facility | | $3,345.29 | $6,516.47 | $9,377.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,335.49 / $6,166.69 / $8,502.58
| Professional | | $4,335.49 | $6,166.69 | $8,502.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,876.35 / $5,015.18 / $5,614.99
| Professional | | $2,876.35 | $5,015.18 | $5,614.99 |
- 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
- $3,441.30 / $5,722.30 / $7,676.13
| Professional | | $3,441.30 | $5,722.30 | $7,676.13 |