- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,431.01 / $8,477.27 / $20,928.72
| Facility | | $1,431.01 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,431.01 / $1,431.01 / $8,335.37
| Professional | | $1,431.01 | $1,431.01 | $8,335.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,389.72 / $2,368.82 / $3,158.44
| Professional | | $1,389.72 | $2,368.82 | $3,158.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,308.00 / $3,444.03 / $4,591.35
| Professional | | $2,308.00 | $3,444.03 | $4,591.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,431.01 / $2,504.27 / $4,406.00
| Facility | | $1,431.01 | $2,504.27 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,888.39 / $3,123.11 / $4,300.32
| Professional | | $1,888.39 | $3,123.11 | $4,300.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,717.66 / $3,527.40 / $4,960.68
| Facility | | $1,717.66 | $3,527.40 | $4,960.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,226.09 / $3,166.56 / $4,591.35
| Professional | | $2,226.09 | $3,166.56 | $4,591.35 |
- 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
- $1,888.39 / $3,196.88 / $3,704.16
| Professional | | $1,888.39 | $3,196.88 | $3,704.16 |