- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.01 / $8,477.27 / $20,928.72
| Facility | | $1,995.01 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.01 / $1,995.01 / $11,756.30
| Professional | | $1,995.01 | $1,995.01 | $11,756.30 |
- 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
- $1,934.24 / $3,297.00 / $4,396.00
| Professional | | $1,934.24 | $3,297.00 | $4,396.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,280.00 / $4,883.49 / $6,546.98
| Professional | | $3,280.00 | $4,883.49 | $6,546.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.01 / $3,491.27 / $5,397.57
| Facility | | $1,995.01 | $3,491.27 | $5,397.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,667.70 / $4,411.97 / $6,058.84
| Professional | | $2,667.70 | $4,411.97 | $6,058.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,586.29 / $5,009.08 / $6,927.28
| Facility | | $2,586.29 | $5,009.08 | $6,927.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,351.83 / $4,772.68 / $6,546.98
| Professional | | $3,351.83 | $4,772.68 | $6,546.98 |
- 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
- $2,667.70 / $4,555.62 / $5,745.82
| Professional | | $2,667.70 | $4,555.62 | $5,745.82 |