- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.42 / $8,477.27 / $20,928.72
| Facility | | $2,120.42 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,120.42 / $2,120.42 / $12,510.00
| Professional | | $2,120.42 | $2,120.42 | $12,510.00 |
- 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
- $2,055.67 / $3,503.98 / $4,671.97
| Professional | | $2,055.67 | $3,503.98 | $4,671.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,471.00 / $5,188.03 / $7,034.64
| Professional | | $3,471.00 | $5,188.03 | $7,034.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.42 / $3,710.74 / $5,628.44
| Facility | | $2,120.42 | $3,710.74 | $5,628.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,839.01 / $4,695.28 / $6,446.36
| Professional | | $2,839.01 | $4,695.28 | $6,446.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,683.34 / $5,379.55 / $7,155.60
| Facility | | $2,683.34 | $5,379.55 | $7,155.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,477.61 / $4,735.76 / $7,034.64
| Professional | | $3,477.61 | $4,735.76 | $7,034.64 |
- 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
- $2,839.01 / $4,258.51 / $5,761.00
| Professional | | $2,839.01 | $4,258.51 | $5,761.00 |