- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,040.04 / $8,477.27 / $20,928.72
| Facility | | $2,040.04 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,040.04 / $2,040.04 / $12,035.40
| Professional | | $2,040.04 | $2,040.04 | $12,035.40 |
- 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
- $1,977.16 / $3,370.15 / $4,493.55
| Professional | | $1,977.16 | $3,370.15 | $4,493.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,319.38 / $4,988.58 / $6,769.32
| Professional | | $3,319.38 | $4,988.58 | $6,769.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,040.04 / $3,570.07 / $5,399.90
| Facility | | $2,040.04 | $3,570.07 | $5,399.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,731.47 / $4,517.43 / $6,201.52
| Professional | | $2,731.47 | $4,517.43 | $6,201.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,505.29 / $5,175.58 / $6,784.89
| Facility | | $2,505.29 | $5,175.58 | $6,784.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,246.85 / $4,601.76 / $6,769.32
| Professional | | $3,246.85 | $4,601.76 | $6,769.32 |
- 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
- $2,731.47 / $4,664.51 / $5,883.16
| Professional | | $2,731.47 | $4,664.51 | $5,883.16 |