- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $18,197.01 / $63,095.73
| Facility | | $13,182.57 | $18,197.01 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,918.31 / $7,244.36
| Professional | | $5,888.44 | $6,918.31 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,079.46 / $20,417.38
| Facility | | $3,801.89 | $7,079.46 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $5,128.61
| Professional | | $208.93 | $208.93 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,000.00 / $25,118.86
| Facility | | $3,311.31 | $10,000.00 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $10,232.93 / $12,302.69
| Professional | | $9,772.37 | $10,232.93 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $8,511.38 / $8,912.51
| Professional | | $2,137.96 | $8,511.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Professional | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Facility | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $8,511.38
| Professional | | $1,548.82 | $2,187.76 | $8,511.38 |